Walk for Awareness – Virtual, Fall 2021

Englewood Health Walk for Awareness 2021

All-In on the Fight Against Breast Cancer

A virtual event

Sunday, October 24, 2021
1:00 – 3:00 p.m.

Are you ready to make a difference in the fight against breast cancer?

Join us and help raise funds to provide diagnosis and treatment for noninsured and underinsured members of our community who otherwise could not afford care.

With

Jennifer Ashton, MD

Chief Medical Correspondent for ABC News
Honorary Co-Chair

Nina Pineda

WABC-TV Broadcast Journalist
Honorary Co-Chair

Registration

Register at www.walkforawareness.org

Englewood Health’s Emergency Medical Services receives American Heart Association’s Mission: Lifeline EMS Gold Plus Achievement Award

September 8, 2021 — Englewood Health’s Emergency Medical Services (EMS) has received its fifth consecutive American Heart Association’s Mission: Lifeline® EMS Gold Plus Achievement Award for the implementation of specific quality improvement measures used to treat patients who suffer severe heart attacks.

“It is an honor to be recognized by the American Heart Association for our dedication to providing optimal care for heart attack patients,” said Rick Sposa, director of emergency medical services at Englewood Health. “Our EMS team uses proven knowledge and guidelines to ensure patients have the best possible chance of survival.”

More than 250,000 people experience an ST elevation myocardial infarction (STEMI), the deadliest type of heart attack, every year. Caused by a blockage of blood flow to the heart, this requires timely treatment. To prevent death, it is critical to restore blood flow as quickly as possible.

“EMTs and paramedics play a vital part in the system of care for those who have heart attacks,” said Tim Henry, MD, chair of the Mission: Lifeline Acute Coronary Syndrome Subcommittee. “Since they often are the first medical point of contact, they can save precious minutes of treatment time by activating the emergency response system that alerts hospitals to an incoming heart attack patient.”

“I am incredibly proud of the hard work and dedication of our EMTs, paramedics, and supervisors in bringing state of the art cardiac care to the communities we serve. This is a well-deserved acknowledgment of the excellent care provided by our entire EMS team,” said Barbara Schreibman, MD, EMS medical director at Englewood Health.

The Mission: Lifeline program evaluates how well an organization reduces barriers to prompt treatment for heart attacks—starting from when 9-1-1 is called, to EMS transport, and continuing through hospital treatment and discharge.

Applicability of Percutaneous Procedures For CAD Increases

The continually improving treatment of coronary artery disease (CAD) has benefited from advancements in cardiology, interventional cardiology and cardiovascular surgery, a three-pronged multidisciplinary approach backed by accumulating research (J Am Heart Assoc 2020;9[8]:e05035). Appropriate, evidence-based options—from diet and exercise programs, pharmaceutical regimens, percutaneous coronary intervention (PCI) procedures, and cardiac surgery—have their place across the continuum of care.

“With the advent of new technologies and techniques, we’re able to treat more and more complex disease using percutaneous approaches and avoid open heart surgery,” explained Joseph De Gregorio, MD, the executive director of cardiovascular services and chief of invasive cardiology at Englewood Health, who is also an interventional cardiologist at Bart De Gregorio, MD, LLC, in Glen Ridge, part of the Englewood Health Physician Network.

Studies have shown that PCI will ease symptoms and improve quality of life (Am Fam Physician 2018;97[6]:376-384). PCI, first developed 40 years ago, also has advanced with new technology and techniques. Research, like that presented at the American College of Cardiology 2020 annual meeting, has found that modern cardiac stenting can have comparable results to that of coronary artery bypass grafting (Circulation 2020;141[18]:1437-1446).

“The evolution of minimally invasive interventional technology has been transformational,” Dr. De Gregorio said. “And it continues to evolve, so there will be more and more that we can do for patients to fix their coronary arteries.” As one example, patients who have chronic total occlusions have alternative treatments that don’t require open heart surgery. Less invasive PCI may be an option.

Alongside these developments, procedures are now indicated for sicker patient groups. “We can now perform interventional cardiology procedures for patients who, in the past, were considered high-risk and may not have had many or any options, especially those with very poor heart muscle function,” said Aron Schwarcz, MD, an interventional cardiologist with Cardiovascular Associates of North Jersey. “Patients considered as high-risk surgical candidates, or even too high risk for surgery, can now be treated safely with stenting procedures. It gives us another
alternative to surgery.”

For patients who are having a heart attack or who have severe CAD and are undergoing a PCI procedure, Englewood Health cardiologists use the Impella (Abiomed) device, the world’s smallest heart pump. The Impella device is inserted into the heart through the femoral artery, which then mimics the heart’s pumping and emptying actions, explained Dr. Schwarcz, who co-leads Englewood Health’s chronic total occlusion program.

“With the Impella device, patients who have severely weakened heart muscle or are in congestive heart failure with unstable vital signs—for example, from a severe heart attack—can be treated in a safe manner, where in the past there might not have been an option for them,” Dr. Schwarcz said. “This is especially important for patients who are too sick for cardiac surgery. We now have more treatment options for saving this person’s life.”

Dr. De Gregorio agreed: “We use it in cases of acute [myocardial infarctions] who are hemodynamically unstable or hypotensive, in complex coronary interventions, and in people who have bad left ventricle function or weak heart muscles—that is, cardiomyopathies.”

A New Approach to Calcified Arteries

One potential roadblock to a successful PCI has been arterial calcification, which can create an environment too rigid to allow expansion of the artery, said Omar Hasan, MD, an interventional cardiologist at Englewood Health. However, a new device, recently given premarket approval by the FDA, has overcome this obstacle through lithotripsy, a technique often used to fracture kidney stones. The device, Shockwave Intravascular Lithotripsy (Shockwave Medical Inc.), uses sonic pressure waves to create fissures in the artery’s calcium deposits, allowing the artery to then be expanded at a low pressure to introduce a stent.

A recent prospective, multicenter trial of the device (N=431) published in the Journal of the American College of Cardiology (2020;76[22]:2635-2646) found procedural success in 92.4% of cases (P<0.0001), with 92.2% of patients avoiding any major adverse cardiovascular events (P<0.0001). The Shockwave device is now available at Englewood Health—one of relatively few sites in the Northeast, according to Dr. De Gregorio, and further proof that Englewood Health’s interventional capabilities are at the forefront of the science.

“Calcification has been a major limiting factor for successful PCI, so having this new technology in our armamentarium can open up procedures to more patients,” Dr. De Gregorio said.

Along with the latest generation of medical devices and medications, there is the intangible asset of clinical care, of which Englewood is rightly proud. “Caregivers get to know their patients well,” Dr. Hasan said. “It’s more of a personal touch, personal care, and the best physicians available,” he said.

Posted August 27, 2021


Internal Medicine Physicians Alyssa Becker, MD, and Nina Safa, MD Join Englewood Health

Primary Care Doctors Welcome New Patients to their Fair Lawn Practices

August 25, 2021 — Internal medicine physicians Alyssa Becker, MD, and Nina Safa, MD, have joined Englewood Health. Their main clinical interests are adult health, geriatric medicine, cancer prevention and cancer survivorship, chronic condition management (including heart disease and diabetes), health screenings, prevention, and wellness. Dr. Becker and Dr. Safa join HVA Medical Group, part of the Englewood Health Physician Network, and welcome new patients to their primary care practices located in Fair Lawn.

The providers joining the Englewood Health Physician Network are:

Alyssa Becker, MDAlyssa Becker, MD

Internal Medicine | Full profile

Board certified in internal medicine, with additional certification in lifestyle medicine, Dr. Becker received her MD from Jefferson Medical College (now Sidney Kimmel Medical College), in Philadelphia, and did an internal medicine residency at Thomas Jefferson University Hospital.

“I am a caring and compassionate physician who believes in a whole-person approach to health and healing with integration of traditional medicine and complementary/alternative practices,” said Dr. Becker.

Nina Safa, MDNina Safa, MD

Internal Medicine | Full profile

Board certified in internal medicine, Dr. Safa received her MD from Temple University School of Medicine, in Philadelphia, and did an internal medicine residency at Temple University Hospital. She is a member of the American College of Physicians and the American Medical Association. In addition to English, Dr. Safa is fluent in Farsi.

“I take pride in practicing a dedicated and compassionate approach to providing care for my patients. My aim is to ensure the continuing health of my patients while educating them on how to lead a healthy lifestyle,” said Dr. Safa.

Englewood Health’s Maternal/Child Services Achieve Healthgrades Recognition Six Years in a Row

August 24, 2021 — Englewood Health has received the Healthgrades 2021 Labor and Delivery Excellence Award, Obstetrics and Gynecology Excellence Award, 5-star recognition for Vaginal Delivery, and 5-star recognition for C-Section Delivery, all for six years in a row. The Labor and Delivery Excellence Award places Englewood Health in the top 5% of all hospitals evaluated and recognizes the exceptional care of mothers during and after labor and delivery, according to Healthgrades, the leading resource that connects consumers, physicians, and health systems.

In addition, the Obstetrics and Gynecology Excellence Award recognizes Englewood Health for exceptional care of women during and after labor and delivery, as well as care of women undergoing gynecologic procedures. Englewood Health is in the top 5% of hospitals evaluated for overall women’s care.

“These acknowledgments by Healthgrades speak to the commitment of our team to provide exceptional care for women,” said Kathleen Kaminsky, MS, RN, NE-BC, senior vice president of patient care services and chief nursing officer at Englewood Health.

Obstetricians and gynecologists, along with other maternal/child health specialists at Englewood Health, provide the full spectrum of services including prenatal care, high-risk testing and monitoring, childbirth education, and post-pregnancy resources and support.

“Now more than ever, there is a heightened awareness around the importance of quality healthcare, especially for expectant mothers and their families,” said Brad Bowman, MD, chief medical officer at Healthgrades. “Women who seek care at a hospital that has achieved these recognitions can have confidence in the organization’s commitment to delivering superior care.”

“At Englewood Health we are dedicated to offering the best possible experience for women leading up to and throughout labor and delivery,” said Jamie Ketas, vice president of quality at Englewood Health. “We are honored to receive this recognition of our commitment to providing outstanding care.”

To help consumers evaluate and compare hospital performance, Healthgrades analyzed patient outcomes data for hospitals across 16 states that provide all-payer state data for 2017 through 2019. Healthgrades found that the variation in hospital performance makes a significant difference in terms of clinical outcomes.

From 2017 through 2019, patients treated in hospitals receiving the Healthgrades Labor and Delivery Excellence Award had, on average, a 41.7% lower risk of experiencing a complication while in the hospital than if they were treated in hospitals that did not receive the award.* Patients treated in hospitals receiving the Healthgrades Obstetrics and Gynecology Excellence Award had, on average, a 37% lower risk of experiencing a complication while in the hospital than if they were treated in hospitals that did not receive the award.*

During this time, if all hospitals included in the analysis performed similarly to those that received the Healthgrades Labor and Delivery Excellence Award, complications could potentially have been avoided for 138,318 patients.* If all hospitals included in the analysis performed similarly to those that received the Obstetrics and Gynecology Excellence Award, complications could potentially have been avoided for 155,179 patients.*

Additionally, Healthgrades found that there is a significant variation in hospital quality between those that have received 5 stars and those that have not. For example, from 2017 through 2019, women having a vaginal delivery in hospitals rated 5-star have, on average, a 43.6% lower risk of experiencing a complication while in the hospital than if they were treated by hospitals rated 1-star.* Women having a C-section delivery in hospitals rated 5-star have, on average, a 59.2% lower risk of experiencing a complication while in the hospital than if they were treated by hospitals rated 1-star.*

*Statistics are based on Healthgrades’ analysis of all-payer data for years 2017 through 2019 and represent 3-year estimates for patients in 16 states for which all-payer data was made available.

Englewood Health Redesignated by Magnet Recognition Program for Excellence in Nursing

One of just 30 hospitals nationwide to earn honor five times

August 20, 2021 — Englewood Health received its fifth Magnet recognition, reinforcing a continued dedication to high-quality nursing practice. The American Nurses Credentialing Center’s Magnet Recognition Program distinguishes nursing excellence by measuring performance across a number of components. Magnet recognition is the highest national honor for nursing practice.

“We are proud to be among the 9 percent of hospitals in the nation to have earned this recognition for high-quality patient care, nursing excellence, and innovations in professional nursing practice,” said Kathleen Kaminsky, MS, RN, NE-BC, senior vice president of patient care services and chief nursing officer at Englewood Health. “Our repeated achievement highlights our commitment to providing outstanding evidence-based care and prioritizing patient safety.”

Englewood first received Magnet recognition in 2002 and has held the honor continuously since then. It is one of just 30 hospitals in the nation to earn recognition five times.

In addition to earning Magnet recognition for overall nursing excellence, the hospital was recognized for four specific exemplary professional practices related to reducing hospital-acquired infections, preventing surgical errors, and improving pain management for patients. 

Research demonstrates that Magnet recognition provides specific benefits to healthcare organizations and their communities, such as:

  • Higher patient satisfaction with nurse communication, availability of help, and receipt of discharge information.
  • Lower risk of 30-day mortality and lower failure-to-rescue rates.
  • Higher job satisfaction among nurses.
  • Lower nurse reports of intentions to leave their positions.

“Earning this designation during such a challenging time is a testament to the dedication of each and every team member,” said Warren Geller, president and CEO of Englewood Health. “As the need for high-quality and compassionate care has only grown throughout the COVID-19 pandemic, it is heartwarming to see everyone join together to meet the needs of the communities we serve.”

The Magnet Model used by the ANCC assesses the quality of nursing leadership and coordination and collaboration across specialties, as well as the processes for measuring and improving quality and delivery of superior patient care. Organizations are evaluated on the degree to which leaders transform the organization to meet changing needs; empower staff members and prepare them to face all challenges; promote exemplary professional practice; foster innovation, clinical practice, and systemic improvements; and measure and evaluate outcomes.

Healthcare organizations must reapply for Magnet recognition every four years. An organization reapplying for Magnet recognition must provide documented evidence to demonstrate how staff members have sustained and improved Magnet concepts, performance, and quality over the four-year period since the organization received its most recent recognition. The application process also includes an opportunity for patients and the public to share their personal experiences at the hospital.

About ANCC’s Magnet Recognition Program®

The Magnet Recognition Program®—administered by the American Nurses Credentialing Center, the largest and most prominent nurses credentialing organization in the world—identifies healthcare organizations that provide the very best in nursing care and professionalism in nursing practice. The Magnet Recognition Program® serves as the gold standard for nursing excellence and provides consumers with the ultimate benchmark for measuring quality of care. For more information about the Magnet Recognition Program® and current statistics, visit www.nursingworld.org/magnet.

Better Functional Outcomes After Robotic-Assisted Surgery for Colorectal Cancer

Compared with classic open procedures or laparoscopy, robotic-assisted colorectal surgery allows for minimally invasive, highly accurate procedures, which have been shown to have higher functional outcomes, according to a meta-analysis published last year in Surgical Endoscopy (2021;35[1]:81-95).

In the combined analysis of more than 24,000 patients, individuals who received robotic-assisted rectal resection were found to have a lower rate of urinary retention and ileus and higher quality of life when compared with
laparoscopic surgery.

“Robotic-assisted surgery provides the highest level of dexterity and a nearly three-dimensional view so we can better see the patient’s anatomy,” said Peter M. Kaye, MD, a colon and rectal surgeon at Englewood Health. “The surgery is less invasive, there is less pain and there is less time spent in the hospital.”

A dedication to the skilled use of emerging surgical technologies, as well as a strong multidisciplinary team approach, has allowed Englewood Health to offer cutting-edge therapies for patients with colorectal and digestive cancers.

The team at Englewood Health has completed more than 1,000 robotic resections for cancer. “We are the most experienced robotic colorectal surgeons in the area,” Dr. Kaye said. “This is what we’re trained to do.”

One important benefit of the robotic approach is the decreased rate of conversion to an open procedure, which in turn reduces postoperative complication rates and allows for a faster interval to completing chemotherapy (Ann Laparosc Endosc Surg 2020;5:9). Being able to perform complex surgeries in a minimally invasive way also benefits patients by decreasing the need for devices, such as colostomy bags.

“Very few surgeons have the technical ability to conduct sphincter-sparing surgery,” said Anna Serur, MD, the chief of colon and rectal surgery at Englewood Health (J Gastrointestinal Surg 2014;18[7]:1358-1372). “Fortunately, we have the special expertise to do these challenging procedures.”

Drs. Serur and Kaye also emphasized the importance of Englewood Health’s strong, multidisciplinary approach to managing patients’ cancers.

“We work very closely with a patient’s medical oncologist, radiation oncologist, with all of the specialties involved in the patient’s care,” Dr. Kaye commented.

Dr. Serur agreed that the team approach in the cancer center is part of what makes Englewood Health stand out. “We take pride in providing excellent care and outcomes,” she said. “We use the latest techniques and medicines, and follow best practices and national recommendations as they are released. We provide our patients with an experience that is special.”

Posted August 20, 2021

Hematologist–Oncologist Adam Zayac, MD, Joins Englewood Health

August 17, 2021 — Hematologist and oncologist, Dr. Adam Zayac, has joined Englewood Health. Dr. Zayac’s main clinical interests are blood cancers, including leukemia and myeloma; other blood disorders, including anemia, bleeding and clotting disorders, bone marrow failure, sickle cell disease, and white blood cell disorders; and lymphoma. He joins Hematology/Oncology Physicians of Englewood, part of the Englewood Health Physician Network, and welcomes new patients to his practice, in Englewood.

“It is my passion and privilege to treat my patients with the most effective methods available while providing the education to empower them and their loved ones on their journey toward healing,” says Dr. Zayac. “With the help of a comprehensive care team, I hope to achieve the best possible outcome for each individual while delivering the compassionate care that I would want for my family and friends.”

He adds, “I have been involved in international, outcomes-based research projects across multiple types of lymphomas. I plan to grow the clinical trials program in common hematologic malignancies to provide additional opportunities to bring cutting-edge therapies to our patients.”

Specializing in hematology and oncology, Dr. Zayac received his MD from the University of Buffalo Jacobs School of Medicine and Biomedical Sciences, in Buffalo, NY. He did an internal medicine residency, and was chief resident, at Upstate University Hospital (SUNY Upstate Medical University), in Syracuse, NY, followed by a hematology and oncology fellowship at Lifespan Rhode Island Hospital (Warren Alpert School of Medicine of Brown University), in Providence, RI. He is a member of the American Society of Clinical Oncology, the American Society of Hematology, and the American Society for Transplantation and Cellular Therapy.

“I am proud to welcome Dr. Zayac to our team of renowned specialists. With his knowledge and expertise, we will expand our Hematology/Oncology team further in order to meet an important need in the community, said Dr. Minaxi Jhawer, chief of hematology and oncology at Englewood Health.

Advances in Cardiologic Assessment For Oncology Patients

While cardiac toxicity from chemotherapy treatments is a known challenge in oncology, previous imaging techniques have sometimes missed spotting affected patients. Now, a novel imaging technology, speckle tracking echocardiography, allows for earlier and more accurate monitoring of heart function in a variety of oncology patients (Tex Heart Inst J 2020;47[2]:96-107).

“Although cardiology assessment of oncology patients is a rather new specialty, the effect of certain chemotherapy drugs on the heart has been known for many years,” said Jay A. Erlebacher, MD, a cardiologist in the Englewood Health Physician Network. “However, as some of these treatments have become the backbone of treatment for many diseases, particularly breast cancer, it is increasingly important to detect the toxicities of oncology drugs, which are potentially toxic to the heart.”

Dr. Erlebacher said it is crucial that these toxicities be detected as early as possible so adverse consequences on the heart can be avoided.

The headline drug for treating many cancers is doxorubicin, which is frequently used in breast cancer, but has potential toxicity related to the cumulative dose of the drug, according to Dr. Erlebacher. This can weaken the heart, potentially leading to congestive heart failure (CHF), he added.

Echocardiography is used routinely to monitor heart and valvular function in patients with heart disease or suspected heart disease. “We primarily look at a performance measurement of the heart called ejection fraction [EF], similar to measuring the horsepower of the heart,” said Dr. Erlebacher, who led Englewood Health’s echocardiography lab for the past 25 years. EF measures the percentage of blood that is ejected from the heart with each beat, typically measured between 55% and 70%. An EF that falls by 10 percentage points and drops below 53% has been used as a definition of chemotherapy-induced cardiac toxicity. Advanced echocardiogram machines are now able to recreate the left ventricular pumping chamber in 3D to obtain a more accurate and reproducible EF measurement than older more traditional techniques. Understanding a patient’s EF is an important step in diagnosing and treating disease.

Doxorubicin and the other major cancer drug potentially toxic to the heart, trastuzumab, can lower EF and impair the performance of the heart, which can result in excess fluid in the body. “The legs become waterlogged and swollen, and patients will suffer shortness of breath, the hallmarks of CHF,” Dr. Erlebacher said.

Fortunately, subtle effects that these two drugs can have on the heart may now be detected even before EF begins to decrease.

Speckle tracking echocardiography is a relatively new technology that is more sensitive and capable of measuring heart dysfunction earlier. “Within the heart muscle, there are tiny dots called speckles,” Dr. Erlebacher said. “Extremely advanced processing software actually tracks the motion of each individual speckle within the view of the heart and computes the relative motion of adjacent speckles.”

By measuring these speckles in relative motion as the heart contracts, a measurement of the regional and global function of the heart can be derived via global longitudinal strain (GLS).

“In many ways, GLS is a superior measurement of heart function compared to EF,” Dr. Erlebacher said. “GLS tends to be more reproducible and tends to start going south and becomes worse even before EF is affected. GLS is an ideal way of tracking patients who receive these chemotherapy drugs.”

Patients are monitored both before and during chemotherapy with 3D echocardiography and speckle tracking. Trastuzumab patients are followed every three months, whereas doxorubicin patients are assessed upon completion of drug therapy or when they reach a standardized dose. Doxorubicin patients are tested again six months after completing a course of treatment.

“If the heart function is decreasing, there are a number of treatments that have been shown to improve left ventricular function, similar to therapies for any type of CHF due to reduced heart function, including betablockers and angiotensin-converting enzyme inhibitors,” Dr. Erlebacher said. “But for Herceptin [trastuzumab], simply temporarily withdrawing the drug will usually cause the heart to improve on its own over time. Our goal in working with our oncology colleagues is for our patients to receive their lifesaving chemotherapy without compromising their heart function.”

Posted August 17, 2021

COVID-19 Hits Cardiac Care In Multiple Ways

Cardiac Patients Affected by Shutdowns, Predisposition to Virus; COVID-19 Patients Develop Cardiac Comorbidities

There were no protocols for courses of care, no established therapeutics, no best practices at all for this entirely new virus. “You bet it was different than anything I’ve had to deal with before. This country hasn’t experienced anything like this since 1918,” said Samuel Suede, MD, FACC, the chief of cardiology at Englewood Health and a cardiologist at Cardiovascular Associates of North Jersey, part of the Englewood Health Physician Network.

Even in the event of an extremely virulent flu strain, providers would have a robust body of literature on which to rely. With COVID-19, at the very beginning, it was one part mystery and another part speed. “This thing came on really, really fast,” said Dr. Suede, also the medical director of the Department of Cardiac Rehabilitation and the nuclear cardiology laboratory at Englewood Health. “We didn’t necessarily know how to treat people. We didn’t necessarily know how to triage people. We weren’t sure what precautions were necessary and what weren’t.”

COVID-19 entered the public’s awareness and the medical canon as a disease of the airways. “We thought this was another respiratory virus,” Dr. Suede said. It was also clear from the beginning that there were apparent high-risk populations: the elderly and those with preexisting conditions, such as hypertension, diabetes or cardiac ailments. “We’ve since learned,” Dr. Suede said, “there are a lot of cardiac complications of COVID such as myocarditis, pericarditis, acute myocardial infarction, arrhythmias, pulmonary emboli and thromboembolic events” (JAMA Cardiol 2020;5[7]:811-818; Circulation 2020;141[20]:1648-1655).

A Responsive Health Care System
Englewood Health reacted quickly at the onset of the pandemic. “As we started learning in March about the severity of COVID, we stopped doing all elective procedures to keep the beds available for the COVID patients,” said Mahesh Bikkina, MD, an interventional cardiologist with HVA Medical Group, part of the Englewood Health Physician Network.

To keep the patients safe, “the hospital transitioned very quickly and very early to telemedicine,” said Aron Schwarcz, MD, an interventional cardiologist also with Cardiovascular Associates of North Jersey. “Very few procedures were being performed. The stress lab’s work was closed. Only select inpatients were getting echos.”

As the patient–doctor relationships shifted online, so did the doctor–doctor consults. “The cardiology section has a conference every Wednesday morning, about 40 people, 50 people in a conference room. We decided to continue that conference by Zoom,” Dr. Suede said. “One, attendance has never been better. But secondly, it was an opportunity for us to communicate. So, everyone was very much abreast of what was happening and into our cardiology patients and how we were modifying treatment plans for the COVID population.”

As doctors conferred with one another and with colleagues around the world, the cardiac complications of COVID-19 came into focus. Englewood Health’s administration went to work again, this time creating a COVID-19 cardiac floor. “Any patients who had COVID, who had any either previous cardiac condition or were having some cardiac complications, but did not require an ICU setting, went to that floor,” Dr. Schwarcz said. “Fifty beds, taken care of by cardiologists,” Dr. Bikkina said, “because we can do the best job for those patients.”

The trust in the administration, the faith that providers have in the systems and support, the ability of the whole organization—topdown—to adapt was at the heart of Englewood Health’s response. “I feel very lucky to have worked at Englewood during this pandemic because I think the administration and the medical staff were very responsive, very resourceful, very quick-footed, and instituted a lot of changes and protocols so we can treat this huge influx of very sick patients,” Dr. Suede said.

Cardiac Prophylaxis
Very early in the pandemic, it became clear that “there are two main effects that we see in patients with COVID,” said Dr. Bikkina, who is also an associate professor of medicine at New York Medical College, in Valhalla, N.Y. “One, the virus affecting the heart muscle and the muscle gets weaker; the second, blood clots are forming at a much higher rate in COVID patients.” Englewood Health’s administration and providers alike put their individual competence and readiness to the test.

The COVID–Cardiac floor that the administration implemented at the outset “provided another level of care for all these cardiac patients who may have gone unrecognized, or maybe their cardiac issues may have sort of taken a little bit of a back seat because of COVID,” Dr. Schwarcz said. But it had another, maybe unexpected benefit: the added attention from cardiac specialists.

It wasn’t long before “we realized that there was a high percentage of patients who were having thromboembolic complications. So we started measuring d-dimer levels to determine who needed prophylactic anticoagulation,” Dr. Schwarcz said. With the full support of the administration, “protocols were established by the COVID team and we prophylactically anticoagulated to prevent thromboembolic complications. That really put cardiologists at the front line of this.”

Cause for Optimism
As this article was written, case and mortality rates rose across the United States and the world and may remain high for a period. A potentially underrecognized casualty from early in the pandemic is people “who should have gotten care, but did not get the care that they needed because they were too scared to go to the hospitals, too worried to go to the offices,” Dr. Schwarcz said. Dr. Bikkina highlighted the danger caused by that hesitation. “Even though they’re having chest pain, they do not want to go to the hospital because they’re afraid of COVID, and then they end up having heart attacksand strokes and dying at home.”

In the months ahead, there is cause for optimism. “The treatment that we have now, with [the COVID] testing that we have now, we’ll be able to keep up elective [procedures],” Dr. Schwarcz said. Patients will not have to put off improving their quality of life. Englewood Health will continue to work collaboratively, as evinced by the administration’s pragmatic leadership, working hand-in-hand with the accountability, adaptability and inventiveness of the providers.

“We want to let the public know,” Dr. Bikkina said, “when a new patient comes, it is very safe for them to get the care that is needed for them.”

Posted August 16, 2021