Coronary heart disease is the single leading cause of death in America. In San Diego, hospitals and medical centers have established and share some of the most advanced cardiac care programs.

The Scripps Beat

Scripps has five hospitals in San Diego. Cardiac patients are treated at four of them: Scripps Green Hospital, Scripps Memorial Hospital La Jolla, Scripps Mercy Hospital and Scripps Memorial Hospital Encinitas.

Scripps Memorial Hospital La Jolla sees the highest volume of cardiac catheterizations, with more than 1,000 each month, or about 40 percent of the county’s 2,800. Overall, Scripps hospitals account for 47 percent of the total number of cardiac caths.

This year Scripps will open new catheterization labs at Scripps Encinitas and Scripps Chula Vista. The procedure involves a tiny tube painlessly inserted into arteries and blood vessels. Crucial for accurate diagnosis of a variety of heart conditions, it gives physicians an inside look at the heart.

Scripps hospitals treated 13,153 cardiovascular patients in 2000, 31 percent of those in San Diego County, making it the region’s leader in cardiovascular care.

In addition, Scripps provides specialized services at its different hospitals. Scripps Green is renowned nationally and internationally for its Interventional Cardiology Program. The institution pioneered stent implantation, antibiotic coded stents and brachytherapy techniques in Southern California.

Scripps La Jolla pioneered the use of catheter ablation in San Diego to cure arrhythmias, and was the first hospital in Southern California to correct Wolff-Parkinson-White syndrome, a condition that can cause potentially deadly fast heart rates.

Scripps Green, La Jolla and Mercy have been involved in pioneering research studies including the use of the latest clot-preventing medications and peripheral radiation.

Connecting With Kaiser

That strong record and reputation has led to a contract between Scripps and Kaiser Permanente that allows Kaiser the use of Scripps’ cardiac catheterization laboratory and some of its surgeons.

“We do the angiograms at Scripps, we do the interventional procedures at Scripps,” says John Verkleeren, Kaiser’s chief of cardiology. “And we have a contract with the Scripps physicians to do open heart surgery and valve replacements if we need it.”

Kaiser has its own cardiologists who do angiograms and interventional cardiology. But if patients need open heart surgery, a contracted Scripps surgeon is used. Kaiser does not have its own cardiac catheterization laboratory or cardiovascular surgery program. “It takes a lot of effort to get a program with the really good surgeons like they have up there,” Verkleeren says of Scripps. “Our relationship with these surgeons has been outstanding and we’re very happy with the results that we have with them doing our procedures.”

The arrangement has been in place for about 20 years. “It’s different than the other hospitals, but we’re all on the same team trying to take care of the patient,” Verkleeren says.

Kaiser, with more than 500,000 county members, saw 3,760 new cardiac patients in 2001. About 1,100 were treated for intervention and about 1,700 for catheterization. Richard Fortuna is part of the unique relationship between Kaiser and Scripps. Stationed at Scripps but on Kaiser’s payroll, he is co-director of the cath lab at Scripps and the director of interventional cardiology for Kaiser. “I think patients accept the inconvenience of being hospitalized at a central facility because the care is so good,” he says. “Not only is the hospital as well as the cath lab used to a high volume of patients, but the surgeons are used to a high volume of patients too.”

Last year, Kaiser cases represented 49 percent of the total cardiac cases at Scripps La Jolla.

UCSD’s Specialties

The UCSD Cardiovascular Center operates UCSD Medical Center, Hillcrest; UCSD Medical Center, Thornton Hospital in La Jolla; and VA Medical Center. In its role as a research institution and teaching hospital, UCSD says it is on the leading edge of translating research to patient care on a daily basis.

In 2001 there were 1,644 cardiac admissions at UCSD’s hospitals. The Cardiovascular Center’s programs and services include: noninvasive and invasive cardiology (electocardiography, stress tests, pacemaker evaluations, biopsies, angioplasties); electrophysiology (arrhythmia mapping and surgery, drug therapies, catheter ablation); cardiothoracic surgery (valve repair and replacement, bypass, thoracic and pediatric open heart surgery); heart and lung transplantation; cardiomyopathy program (consultation, diagnostic testing and treatment for congestive heart failure, especially systolic left ventricular dysfunction); pediatric cardiology (noninvasive diagnostic testing, cardiac catheterizations including new techniques and devices, electrophysiology studies, etc.).

UCSD’s many firsts in San Diego and Imperial County cardiac care include a pediatric heart transplant, heart-lung transplant and the first minimally invasive coronary artery bypass surgery.

Sharp’s Points

Three of Sharp’s hospital systems offer specialized cardiac care.

Sharp Memorial Hospital provides the broadest range of cardiac services in the Sharp system, ranging from heart transplants to cardiac rehabilitation.

Sharp Memorial has three full-service interventional labs; left and right side of the heart catheterization; and endomyocardial biopsy (35 per month/transplant service). Patients needing noninvasive cardiology average 2,600 EKGs, 400 cardiac echocardiograms and 150 stress tests on a monthly basis.

Sharp Memorial performs about 500 cardiac surgeries with more than half involving bypass. The rest of the caseload includes valves, aneurysms, congenital repair, myxomas, ventricular assist device implantation and pulmonary thromboendarterectomy.

Sixteen heart transplants were performed at Sharp Memorial last year, making it the busiest heart transplant program in San Diego. Sharp also provides the Mechanical Assist Device program, an alternative now to patients who are not eligible for transplant. This effort has made Sharp Memorial a leader in Southern California and the nation for mechanical support of the heart and lungs. Sharp’s program offers state-of-the-art mechanical support for patients waiting for a transplant.

Eight mechanical assist devices are available at Sharp. Since 1986, Sharp HealthCare has provided this help to more than 200 patients and has participated as an investigation center for many of these devices as they were being developed. Sharp Memorial was one of 20 national centers investigating the Random Evaluation of Mechanical Assistance for Treatment of Congestive Heart Failure Study, and the only center in California.

Sharp is supporting four people on the Heartmate Ve Lvas living at home in San Diego. To date, the longest a Sharp patient has lived with the Heartmate Ve Lvas is nearly four years.

Sharp Grossmont offers the East County’s most comprehensive cardiac care. Its catheterization lab provides invasive and noninvasive procedures.

Sharp Chula Vista is the only hospital in the South County to perform cardiac surgeries, handling 410 cases in 2002. Sharp Chula Vista also performed 1,796 cardiac catheterizations and another 329 coronary interventions (angioplasty and stent placements). About 260 cardiac rehabilitation exercise classes averaging 12 patients each session resulted in 3,120 total visits last year. Additionally, more than 3,000 echocardiograms, 1,200 stress tests and 5,000 electrocardiograms were performed last year.

The Paradise Valley Hospital cath lab is home to the newest cardiac care equipment. The staff includes, from left: Steven Davies, Josie Martir, Dr. Genaro Fernandez, Mario Guerra, David Selleck and Dr. Jerome Robinson. (photo/lambertphoto.com)

The Cardiology Department at Paradise Valley Hospital offers a variety of noninvasive tests for the assessment of cardiac and or vascular disease. In 2001, the hospital saw 26,141 cardiology cases and in 2002, 22,062 cases. Paradise has the newest cath lab in the South County. Open a year and a half, the lab has treated more than 650 cases with its cutting-edge digital equipment. Although the lab is equipped to do things like angioplasty and implanting stents, pacemakers and internal defibrillators, it does not have the capabilities to perform elective open heart surgery.

Much like the contract Kaiser has in place, Paradise Valley has an agreement with Sharp Chula Vista to perform open heart surgeries. Intervention procedures also are done at Scripps La Jolla. “Both of our cardiologists, we have two of them who are interventional cardiologists, practice at those two places,” says David Selleck, manager of the Paradise Valley cath lab. “They take their patients down there to do the interventions as both those hospitals have open heart surgery available.”

During emergency situations, Paradise Valley cardiologists can and do perform heart surgeries. When an operation can be scheduled, it is moved to the appropriate partner hospital. So far, this arrangement has been serving Paradise Valley well. But the hospital is looking at getting its own heart program in two to three years. The cath lab just recently began performing electrophysiology studies, mapping of the heart for people with life-threatening arrhythmia to pinpoint the problem.

By working together, doctors at San Diego hospitals are able to provide better care. “It’s an integrated approach to patient care,” says Fortuna at Scripps. “We’re not competing with anyone. We’re all on the same team trying to care for our patients.”