Shanna M 00:11
Hello, Welcome to the Adventist HealthCare and You Podcast. I'm Shanna

Nimeet K 00:14
and I’m Nimeet.

Shanna M 00:15
February is Heart Month. And we have an excellent guest today to talk about heart care. Dr. Michael Chen, who is the director of cardiac catheterization lab at White Oak Medical Center and the chair of cardiology at Shady Grove Medical Center. He's with Cardiac Associates. Welcome, Dr. Chen

Michael Chen, MD 00:32
Thank you so much for having me.

Nimeet K 00:33
So Dr. Chen, tell us about yourself, what you do, at Adventist HealthCare? and what's your specialty in Adventist HealthCare?

Michael Chen, MD 00:38
So i'm a interventional cardiologist. And what that means is that when patients come in, if they have blockage in the blood vessels of the heart, then I would put stents in there to open up the blockage, and also take care of general cardiology patients. So, patients with palpitations, skip heartbeats, with heart failure, with like discomfort as well. And I'm Chair of Cardiology over at Shady Grove, and Director of the Cardiac Catheterization Lab at White Oak Medical Center. So at Shady Grove, we take care of a lot of heart attack patients, we're very busy heart attack center there, and we open up blockages for patients, especially, it can be in the middle of night, on the weekends, patients who are having heart attacks, and then at White Oak, being director of the Cardiac Cath lab there, we're much busier, larger cardiac catheterization lab, we do more procedures there. And there we do procedures ranging from stents for patients who are outpatients, to heart attacks as well. And then we also do a structural heart disease and peripheral arterial disease. So that can be patients with blockage in the neck, blockage in the leg, we can fix those. And we have a structural heart disease team that can actually put in heart valves there, without having to open up the chest.

Shanna M 00:39
So that's one of the things that's special about Adventist HealthCare and the Heart and Vascular Institute is we have these two-community hospital, but we offer a lot of advancements in heart care that you don't, you don't have to travel for.

Michael Chen, MD 01:56
Yes, exactly. So Shady Grove is probably one of the busiest heart attack centers in the state of Maryland. And we provide excellent care there in terms of saving lives. When people come in with a heart attack, their heart is not getting enough blood flow. And so we opened that blockage and they feel better. And that can, that's been proven to save lives, then White Oak, as you point out, that's our tertiary care center. And we have a lot more specialized procedures that we do bypass surgery there and valve surgery there.

Shanna M 02:23
Okay, well, I don't think that's something that people know that Shady Grove Medical Center is one of the busiest heart attack care centers in Maryland, both of our hospitals offer some of the best cardiac care in the state. So we're really proud of that.

Nimeet K 02:38
Absolutely. And I think in just a couple of minutes that you're describing what you do, I think, you packed in so much in there in just two minutes. I think people don't realize how much work goes into it, what goes into relieving a blockage and what kind of medications you're on and what kind of non-invasive procedures there are nowadays, that are there with decreased risk for for surgeries with minimal, minimally invasive

Michael Chen, MD 03:00
right now, actually, I would take it that you talked about advances in care. And I totally agree with that. But I think one other thing to point out, both at Shady Grove and also at White Oak is we also have excellent cardiac rehabilitation programs too. So it's not just the cutting edge technology to treat the patients. But then once they've recovered from their heart attack, from their valve surgery, from their TAVR, then we can get them in cardiac rehab, get them exercising, increasing what they can do on a functional basis.

Shanna M 03:29
Yeah, making sure they recover safely and continue to see improvements as well.

Nimeet K 03:35
On the continuity of care, with them having the same, similar teams at a similar place, after they get the surgery too is highly valuable. On the lines of that, like when a patient is looking for new heart doctor or cardiac physician, what are they supposed to look for? What are they supposed to look for our team? What are your some of your recommendations?

Michael Chen, MD 03:52
So I would say first of all, it probably comes down to referrals, referrals being, if I were a patient, I would ask my family member who do you like as your cardiologist, I would ask my friend, my primary care doctor, I think word of mouth is very important and should not be underestimated. Because I think in general, if the patient's friend or family has had a good experience with a cardiologist, then their cardiologist will probably also treat that patient well, as well.

Shanna M 04:21
So look for somebody that can develop a relationship with you.

Michael Chen, MD 04:24
Yeah. And then after that, then of course, you know, there are many doctor rating sites. You can look at those. Sometimes those can be gamed, but it's probably at least worth taking a look at. Yeah. And then along those lines, you can you probably also want to check into the doctor's credentials, and credentials. Now if they're from very good institutions that can be beneficial. However, that's not the be all or end all. There can be very smart doctors from great institutions, but if they don't have good bedside manner if they can't communicate with the patients, if you know that that's really not that beneficial. You need a doc, at least as a patient you needed a doctor who you'd be comfortable with and are willing to work in partnership with. I always tell my patients, hey, when I'm treating you, this is a partnership, and we work together to make the best decisions for you. It's not going to be me dictating, here's what you need to do. But what can we do together to make your health the best?

Shanna M 05:11
Yeah, I think it's really important. What you said, though, is do your, is do some research.

Michael Chen, MD 05:15
Yeah.

Shanna M 05:16
But, it's okay to do that and find the right person for you. And looking around is a good place to start. Because I think sometimes people don't know what to do, you know, how do I go about even finding somebody that, you know, my doctor says, I need a cardiologist? Where do I even start?

Michael Chen, MD 05:32
Right?

Shanna M 05:32
So that was good advice.

Michael Chen, MD 05:34
And then along those lines, too I guess, then if you need a procedure done via a catheterization, well that's a procedure where we go in and take a look at the blood vessels of the heart, or say, maybe and electrophysiology procedure like a pacemaker, defibrillator, then you may, then I think it's fair, you probably do want at least ask the doctor, how long have you been in practice for? How many procedures have they done? Get a sense of experience?

Shanna M 05:57
Yeah

Nimeet K 05:58
I think you mentioned that in Adventist HealthCare, we've done a tremendous amount of procedures, and also more of a one stop shop where if you do get a procedure done, I think the rehab factor kicks in significantly as well. And that's something people should look for at an institute, at least when they're picking their provider.

Michael Chen, MD 06:13
Yeah, absolutely. I mean, you talked about kind of one stop shops there. So beyond cardiac rehab, just to mention a, I wouldn't call it cutting edge technology, but a very unique capability of Adventist Healthcare is, I believe we are, if not may, we may be the only one, if not then one of the few hospitals in Maryland to offer EECP. And what EECPs, Enhanced External Counter Pulsation that's basically a treatment done actually through cardiac rehab as well, where the Rehab people would put pumps on the patient's legs, and they kind of pump it back and forth for about an hour or so. And what that is for is for patients who have pretty severe coronary artery disease, to the point where often you can't do anything further for them, but they're still having chest discomfort. They're not a good case for surgery, you can't do any more stents, but they're still having angina, still having chest discomfort. And so this EECP has had really good results in helping decrease the amount of angina, the amount of chest discomfort that someone has, and proud to say that Shady Grove hospital may be one of the few, if not the only one in Maryland, having this EECP program done as an offshoot of cardiac rehab.

Shanna M 07:16
That's great.

Nimeet K 07:17
That's amazing.

Shanna M 07:17
Yeah. And it's a quality of life, you know, so it may not seem the most advanced, but it's something unique, and it's something that improves the quality of life of someone, which is really important when trying to live with heart disease.

Michael Chen, MD 07:31
Yeah, super important.

Shanna M 07:33
Yeah. So we've talked about a couple advances already and some unique offerings, what advances, what other advances in treatment for heart disease and other heart conditions, heart attack, that have come about over the last few years?

Michael Chen, MD 07:46
So there's a couple that come to mind. One would be the change in the approach we take when we're doing cardiac catheterizations. So cardiac catheterizations are when we're going into a patient's blood vessel, into their artery to go up to their heart and take pictures of the blood vessels of the heart. And we're doing that if we're suspicious for any kind of blockage there. So say 10-15 years ago, 90% of procedures were done through the groin, femoral approach, since then, there's really been a shift towards doing them through the wrist called, going through the radial artery. And with that, there's been a lower incidence for bleeding. Patients actually prefer going through the wrist and through the leg piece, because they don't have to lay flat quite as long. And there's better patient outcomes when one goes through the wrist then through the leg. So that's one approach that's really exciting is that now you can get a catheterization done, and then literally up walking around shortly thereafter. Whereas before, if you go into the leg, you might have to be lying flat for two to six hours. So that I mean, that would be one kind of the shift from femoral artery to radial artery catheterization. I'm proud to say, at White Oak Medical Center, we're probably doing maybe, again, it used to be, you know, going through the wrist was maybe 5 to 10% of cases. 10 to 15 years ago. Now, I think at White Oak we're probably around 70% or so. Yeah.

Nimeet K 09:06
That's great. And I think the recovery aspect is probably better too, since it's not through the groin, it's the it's through the wrist. It's less invasive.

Michael Chen, MD 09:12
Exactly. Less invasive.

Shanna M 09:15
You know, heart care has really changed over the last couple of years. You know, there's a lot of minimally invasive ways to go about it now.

Michael Chen, MD 09:21
Yeah. And that would be kind of a good segue into the second thing I'm really excited about. That'd be less invasive approaches to replacing valves. TAVR, we kind of touched on briefly and there the, the Structural Heart team can put in an aortic valve through the groin, without having to open up the chest, through the groin with a minimal, you know, minimally invasive procedure.

Michael Chen, MD 09:40
Yeah. And then I guess the other couple things that I want to talk about, heart failure. So heart failure used to be a death sentence and the prognosis for heart failure still is not great. But we've come a long way in the last 10-15 years with medical therapy for heart failure. And right now there's really four different pillars of heart failure therapy, and whether you call it beta blockers; something called ENTRESTO; MRA's, which are Mineralo Receptor Corticoid Antagonists. And then another class of medicine is called SGLT2 inhibitors. And so with these four classes of medicines, the survival for heart failure has really improved dramatically. And it's very interesting because especially those, this last class called SGLT2 inhibitors, those are medicines like Jardiance, and Farxiga. So go back to about 2014, those actually used to be just medicines for diabetes. And they found that patients with diabetes, who also had some heart problems actually did better. The companies then did specialized trials looking at these medicines, just for heart failure patients, and now these medicines are actually approved for heart failure, independent of diabetes. So, you know, all these myths of heart failure really making a difference in treatment for heart failure.

Shanna M 09:40
Okay.

Shanna M 10:46
Okay.

Nimeet K 10:46
Yeah, I think it's great that, you know, he said, like, just a decade ago, heart failure was almost a death sentence. And now, it's not other options, and there's treatments and there's things that we've seen over the past few years that works. And you know, people could have a better outcome or a better quality of life.

Shanna M 11:02
Shows how much things can change in a relative short period of time to.

Michael Chen, MD 11:07
Right, and that's, that's really rewarding, because that's because we measure your heartbeat, in part by what's called the ejection fraction. That's how much blood is squeezed out of the heart. And normally, it's about 50% or higher. And so we may see someone in the office, ejection fraction, do heart failure, maybe 20%. And then you start them all these medicines. And then, I mean, not all the time, of course, but often, couple months, three months, six months, maybe a year, a couple years later, the ejection factor is back to normal with these medicines. And it's, you know, they're thrilled when they see that and we're delighted for them.

Shanna M 11:35
So we've talked a little bit about some interventions, some medical procedures, medications, ultimately though, what are some tips to be as heart healthy as we can be?

Michael Chen, MD 11:46
I tell my patients to exercise and again, if they, you know, they don't have to go to a gym, they can just even be out walking, out in the neighborhood is fine. This cold weather, you can go to the mall and exercise and walk there. Even if you can't do that you walk up and down your steps, if that's safe, do that several times. That's good exercise.

Shanna M 12:04
Just something. Yeah, just move.

Michael Chen, MD 12:06
Exactly, and then the second thing would be eating healthy. Eating healthy, is so important. It's common sense stuff, but low salt diet, low fat, lots of fruits and vegetables. Fish is better than chicken, chicken is better than red meat.

Nimeet K 12:06
So you mentioned, you mentioned a few things that we do Adventist, at Adventist Healthcare, what are some of the key things that you think we do at Adventist HealthCare specifically, and what's so special about the Heart and Vascular Institute at Adventist HealthCare?

Michael Chen, MD 12:31
So, I think at Shady Grove, we have a very tightly knit STEMI. STEMI is ST Segment Elevation Myocardial Infarction, fancy medical terms, just means this is the kind of heart attack when someone comes in the ER, they must do a EKG and the EKG shows certain changes, then that's a emergency and then we call people in, middle of night, weekends doesn't matter. And we're all there within a half hour and start working on the patient. And we have a great team at Shady Grove, for such, a very tight knit team been working together, you know all of us for the last several years. And then at White Oak, what's really unique there is, is really at the heart care team. So, when patients come in for a procedure, they start in trans care. Trans care is like the pre-procedure area. And the nurses there are fabulous, they always get among the highest rate rankings for the various units at White Oak Medical Center, then they come into the Cath lab and the Cath lab team is experienced, very engaged and do a wonderful job as well. And then they come back out and are taken care of by the trans care nurses along with the nurse practitioners. And between all those people touching the patient at White Oak, we always get very high patient satisfaction scores for our cardiac team at White Oak with the Heart Team approach there.

Shanna M 13:54
I love that you're talking about some of our specific things that you just don't really think about. There's so many people that come in and out and it's probably a pretty frightening experience for someone that could be having a heart attack or is having some issue. What do the teams do to kind of help the patient walk through that? You know, because that's, that can be frightening.

Michael Chen, MD 14:16
Right, I think it's just really treating each patient as an individual, rather than, rather than just, you know, feeling like they're just another patient to get through. You know, get the, take the time, try to get to know them, talk them through the procedure, calm them down, hold their hand, try to distract them. Any of those. Any of that.

Shanna M 14:38
Yeah, so, yeah, combining all that wonderful advancements in science and technology with the compassion.

Michael Chen, MD 14:47
Yeah

Shanna M 14:47
That Adventist HealthCare is known for. One last question, are there any newer tests or things around genetics? We hear genetics being talked about a lot, in in different, for different medical conditions, cancer and other things, but what about for heart? Is genetics kind of a newer area in heart care? Or is that not started yet?

Michael Chen, MD 15:08
Yeah, definitely newer and interesting that you should mention that because Dr. Friedman and I, and myself at Cardiac Associates, we recently completed a pilot program with a small company called Open DNA. And that is looking at polygenic risk scores in patients. So, what polygenic risk scores are basically sampling several genes, and then, through algorithms trying to calculate what is your lifetime risk for developing coronary artery disease, for developing diabetes, for developing high blood pressure. And it was a pretty interesting trial, because these patients, you know, we would see them in the clinic, they would come in, it's just a little cheek swab. Very simple. And it's just sent off, it is then processed, and then you, we get a printout back from the company, let's say, well, you know, based on your, you know, all your genes that are assessed, you may have like a 10% risk of developing heart disease, you're in the 90th, percentile, etc. So, the thinking there being that if someone knows in advance, they're at higher risk of developing heart disease, we may then be more aggressive with lifestyle changes, even with statins to lower cholesterol earlier on.

Shanna M 15:14
Okay, and the earlier you catch it, just like with everything else, the better it is. So, well, thank you for sharing some of these advancements today. And I'm glad you brought up the understanding your risk, being able to make some changes quickly before you have more major issues down the road. Adventist Healthcare, has a heart health risk assessment online, asks a couple questions very, you know, quick and fast, and it can help you kind of understand a little bit more about your risks level too. So, I encourage our listeners to take that so we'll put that resource in the show notes.

Michael Chen, MD 16:33
Actually, you know, one, one other thing you talked about advances, this is actually very important, too. So, obesity is a huge problem throughout. And lately cardiologists are getting more and more involved with dealing with obesity. In terms of there's a medicine out there, it's an injection, it's called you'll, a lot of the listeners may have heard of it, Wegovy.

Shanna M 17:15
Or Ozempic.

Michael Chen, MD 17:16
Exactly, so Ozempic is actually for type two diabetics.

Shanna M 17:19
Okay

Michael Chen, MD 17:20
But then that's been shown to have cardiovascular benefit. And with that then Novo Nordisk did further trials looking at Wegovy, which is the same molecule, Semaglutide. But for patients who do not have diabetes, and actually found that, in these patients who were overweight, who gave, without diabetes, and gave them Wegovy. And if these patients had some cardiovascular disease at the, pre-existing, it actually, not only do they lose weight, probably about 15-17% of their body weight, but then they also have less chance for heart attack, stroke, clinical outcomes, too.

Michael Chen, MD 17:53
So that really could be game changing, as far as we think about as cardiologists, all the overweight patients we have. And now there's a medicine to cut, you know, to help them lose weight, they'll feel better, hopefully exercise more and then actually decrease their chance for having heart attack, stroke, etc.

Shanna M 17:53
Okay

Shanna M 18:09
Trying to run

Michael Chen, MD 18:10
Prevent rather than treat.

Shanna M 18:12
Okay, thank you. Yeah, that's we have addressed that a couple of times on the podcast, in the past, this sort of this newer class, and just weight loss in general. So thanks for bringing up that, in terms of how it can actually help your heart health too. So thank you for coming on Dr. Chen. We appreciate your time today. Thank you for sharing these advancements in heart care.

Michael Chen, MD 18:35
Sure. Thank you for having me.

Shanna M 18:36
Thank you. So to find more information about Dr. Chen, visit AdventistHealthCare.com and click on find a doctor. Information will also be available in the episode show notes today. To learn more about Adventist HealthCare's Heart and Vascular Institute visit AdventistHealthcare.com. We'd also love to hear from you our listeners. You can let us know if you liked the podcast by leaving a review or you can email podcast at AdventistHealthCare.com. And let us know what healthcare topics you want to know more about. Don't forget to subscribe so you get all of our new episodes. Thank you and be well.