CHI Memorial Heart Institute provides advanced cardiac care including structural heart programs, imaging technologies, and interventional cardiology. It has received several awards for quality in areas like heart attack treatment and heart failure care. The report outlines the institute's services, volumes, and outcomes data demonstrating its leadership in cardiac care in the region. It also describes specific programs like those for atrial fibrillation ablation and heart failure management that are improving patient outcomes and quality of life.
2. Our
Mission
The mission of CHI Memorial and Catholic Health Initiatives is to nurture
the healing ministry of the Church, supported by education and
research. Fidelity to the Gospel urges us to emphasize human dignity
and social justice as we create healthier communities.
Reverence | Integrity | Compassion | Excellence
3. 2016 CHI Memorial Heart Report 3
Over the past four decades, The Chattanooga Heart
Institute, CHI Memorial and its physician partners
have made a tremendous impact on cardiac care
in Chattanooga. As one of the southeast region’s
leading heart centers, we are dedicated to providing
the highest quality heart care and advancing the
practice of cardiovascular medicine. Our success is
defined by the outcomes we achieve, the experience
we provide, and the way we empower patients
to manage and control cardiac conditions and,
ultimately, their overall health. Our focus is always to
improve our patients’lives.
CHI Memorial is forward thinking in its approach
to care, and today we provide the most advanced
diagnostics, care protocols, specialty services and
experienced physicians who are at the forefront
of emerging technologies. Our combination of
expertise, technology and convenience mean we are
uniquely positioned to provide the right care at the
right time.
The future of heart care is here now, and our
innovative therapies are changing the way
cardiac conditions are diagnosed and treated. CHI
Memorial’s structural heart program, an approach to
care that uses less invasive procedures to manage
complex cardiac problems, is flourishing with the
expansion of patients who are appropriate for
transcatheter aortic valve replacement. The next
frontier is to expand into the non-surgical treatment
of mitral valve problems in 2016.
Within non-invasive imaging, CHI Memorial has
added cardiac PET/CT, which serves as an alternative
to standard nuclear stress testing and is particularly
useful for patients who have a high BMI. This
advanced technology decreases radiation exposure
while increasing accuracy – ultimately leading to
more appropriate treatment.
Our level of training and expertise, coupled with
the multidisciplinary approach to care is positively
impacting outcomes and patient experience.
In many outcome measures – from coronary
artery bypass graft mortality, bleeding and blood
utilization and others – we exceed national
standards. We are also the highest scoring regional
hospital by Medicare measured patient satisfaction
surveys.
Every physician, nurse and caregiver impacts the
care we provide. This report demonstrates our recent
history and the strong leadership that’s necessary
for sustained growth and improved performance. All
of us at CHI Memorial are proud to share our success
with you. Together, we can improve the quality
of life for heart patients and their families in our
community.
William P. Warren, M.D., F.A.C.C.,
chief of cardiovascular services at
CHI Memorial, chairman of
The Chattanooga Heart Institute
board of directors
Diona Brown, BSN, MSHA, RN, NE-BC,
vice president, cardiovascular services
William P. Warren, M.D., F.A.C.C. Diona Brown, BSN, MSHA, RN, NE-BC
4. 4 Impacting Lives with Advanced Cardiac Care
By the Numbers
STS/Open Heart Surgery
CY2014 STS Avg. Like Hospital
Isolated CABG Volumes 450
Operative Mortality 0.9 2.10% 1.70%
Any Re-Operation 2.70% 3.50% 3.40%
Deep Sternal Wound Infections 0.20% 0.30% 0.30%
Permanent Stroke 0.70% 1.30% 1.10%
Prolonged Mechanical Ventilation 6.40% 8.20% 7.00%
New Onset Atrial Fibrillation 7.20% 23.40% 24%
Total Blood Products Used 21.60% 44.50% 42.80%
Total LOS (median) 6.00% 8.00% 8.00%
30 Day Readmission 6.00% 9.70% 8.50%
Initial Vent Hours (%<6) 59.50% 47.70% 49.50%
IMA Use 99.50% 98.50% 98.70%
*The Society of Thoracic Surgeons’ (STS) 3-star rating is the highest quality patient outcomes rating and only
awarded to a small percentage of cardiothoracic surgery programs in the U.S. CHI Memorial earned a 2-star
rating overall and a 3-star rating for medications.
Other 2014 Open Heart Volumes
Isolated Aortic Valve Replacement 37
Aortic Valve Replacement + CAB 38
Isolated Mitral Valve Replacement 10
Mitral Valve Replacement + CAB 6
Isolated Mitral Valve Repair 11
Mitral Valve Repair + CAB 29
FY15 Volumes for Endovascular,
Peripheral & Vascular
Endovascular 1,334
Abdominal Aortic Aneurysm 77
Carotid Stent Placement 21
Aortagram Abdominal 494
Hemodialysis Catheter Placement 133
Peripheral Vascular 403
Endarterectomy Carotid Artery 149
Vascular 1,117
Endarterectomy Carotid Artery 31
Bypass Coronary Artery, Vasoview 438
5. 2016 CHI Memorial Heart Report 5
CHI
Memorial
CHI
Memorial
Hixson
Inpatient Admissions:
Cardiovascular Surgery,
Interventional Cardiology,
Medical Cardiology, Cardiac
Rhythm Management
3,651 411
Outpatient Visits: Cardiac
Arrhythmia, Chest Pain,
Congestive Heart Failure,
Hypertension, Ischemic Heart
Disease AMI, Ischemic Heart
Disease, MCC, Pulmonary Heart
Disease, Rheumatic Heart
Disease, and other Cardiac and
Health Services
22,118 6,098
Electrophysiology Volumes
Electrophysiology Diagnostic 579
Electrophysiology Interventional 1,988
Ablations 387
ICD Insertions 397
Pacer Insertions 508
FY2015 ACC/Cardiac Cath/PCI
Diagnostic Catheterization Volumes 4,123
Interventional Catheterization Volumes 1,388
Median Time to Immediate PCI for STEMI in Minutes* 55
Radial Usage** 36.33%
STEMI Volumes 252
*Goal <90 minutes/75th percentile **Changing practice to improve outcomes and patient satisfaction
Transcatheter Aortic Valve Replacement 109 Total thru 12/31/2015
Edwards CoreValve 50 CY2015
FY2015 Cardiac Imaging
Echocardiograms 13,044
Cardiac Computed Tomography Scans 1,567
Nuclear Cardiology 4,375
Stress Tests 1,241
Vascular 8,817
6. 6 Impacting Lives with Advanced Cardiac Care
In 2015, CHI Memorial received three separate
awards for the way our cardiac teams provide care
for people with heart issues.
American College of Cardiology Award
for Cardiac Care
CHI Memorial received the NCDR ACTION Registry—
GWTG Platinum Performance Achievement Award,
one of only 319 hospitals nationwide to receive the
honor. It recognizes the commitment and success
in implementing a higher standard of care for heart
attack patients. To qualify for this award, CHI Memorial
consistently followed advanced treatment guidelines
for eight consecutive quarters and met a performance
standard of 90 percent for specific performance
measures.
“This award is a proud achievement for our team
who consistently provides high quality cardiac
care. It reflects the hard work and dedication of
the staff who care for some of our most seriously ill
patients and their families,”said Diona Brown, vice
president, cardiovascular services at CHI Memorial.
“The implementation of these guidelines requires
successful coordination of the cardiovascular team and
emergency personnel. This teamwork is a critical step
in saving the lives and improving outcomes of heart
attack patients.”
Bronze Award for Heart Failure Care
CHI Memorial has
received the Get With
the Guidelines®—
Heart Failure
Bronze Quality
Achievement Award
for implementing specific quality improvement
measures outlined by the American Heart Association/
American College of Cardiology Foundation’s secondary
prevention guidelines for the treatment of patients with
heart failure.
“CHI Memorial is dedicated to improving the quality of
care for our heart failure patients, and implementing
these guidelines helps us accomplish this goal by
tracking and measuring our success in meeting
internationally-respected clinical guidelines,”says Allen
E. Atchley, Jr., M.D., cardiologist with The Chattanooga
Heart Institute at CHI Memorial.
This quality improvement program helps hospital
teams provide the most up-to-date, research-based
guidelines with the goal of speeding recovery and
reducing hospital readmissions for heart failure
patients. CHI Memorial earned the award by meeting
specific quality achievement measures for the diagnosis
and treatment of heart failure patients at asset level
for a designated period. These measures include
evaluation of the patient, proper use of medications,
and aggressive risk reduction therapies.
2015 Mission: Lifeline® Gold Receiving
Quality Achievement Award
This award,
presented by the
American Heart
Association,
recognizes hospitals
that implement specific quality improvement measures
for the treatment of individuals who suffer severe heart
attacks.
The higher standard of STEMI care adopted by CHI
Memorial helps ensure that STEMI patients receive
treatment according to nationally accepted standards
and recommendations. For people who suffer from a
STEMI, or ST-segment elevation myocardial infarction
(complete blockage of blood flow to the heart that
requires timely treatment), implementing these
standards helps reduce barriers to prompt treatment
for heart attacks, beginning with the 9-1-1 call and
continuing through hospital treatment.
In addition to receiving the Mission: Lifeline Gold
Receiving Award, CHI Memorial has also been
recognized as a recipient of Mission: Lifeline’s Gold-Plus
Award, which recognizes the hospital has reached an
achievement score of 75 percent or greater for treating
STEMI transfer patients within 120 minutes.
“We are committed to the highest standard of care
for people suffering from a heart attack,”says Diona
Brown, vice president, cardiovascular services at CHI
Memorial.“We’ve consistently met specific reporting
and achievement measures – and we’re excited for
the community to know about the level of care they’ll
receive when they enter our doors.”
Award Winning Heart Care
CHI Memorial Awarded for Excellence Three Times Over
7. 2016 CHI Memorial Heart Report 7
Atrial fibrillation is an increasing problem and
is the most common type of arrhythmia. The
numbers of AF patients worldwide is estimated
at 33.5 million (.05 percent of the world’s
population). There are five million new cases
diagnosed worldwide per year, and that number is
expected to increase to over 12 million by 2030.
“With roughly five million cases of atrial fibrillation
in the US, the lifetime risk in patients 55 years or
older is approximately 25 percent,”says Gregg
Shander, M.D., electrophysiologist with The
Chattanooga Heart Institute at CHI Memorial.
“The aging population is the biggest risk factor for
this increasing prevalence, and early detection is
critical but sometimes challenging.”
Classic symptoms of AF include palpitations,
dizziness, and chest pain, with more subtle
symptoms presenting as shortness of breath and
weakness. Nearly 1/3 of patients have symptoms
five to 10 years before it’s detected. This is an
important piece because four to nine percent
of patients with the condition will advance to
permanent AF within the first year, and 25 percent
will advance to permanent AF within five years.
Pharmacotherapy and Procedural
Solutions
Because of the comorbidities often associated
with AF – like cardiomyopathies, CAD, renal
insufficiency, and bradycardia – many of the
medical therapies are not
appropriate or effective long
term. Ablation is a method
to treat AF using a catheter-
based system where the
catheter is placed against
the part of the heart causing
the arrhythmia. It’s threaded
through a tiny incision in the
septal wall between the left and
right atria. The catheter in the left
atrium is used to map the heart’s
abnormal electrical pathways.
When the targeted area is identified,
the distal end of the catheter delivers
radiofrequency electrical current to ablate tissue
around the pulmonary veins or at other sources
of erratic electrical signals. The catheter uses an
energy source such as radiofrequency energy,
cryothermy or laser energy to create a lesion
of scar tissue called a conduction block. This
stops the erratic electrical signals from traveling
through the heart. When complete, the catheters
are removed and pressure is applied to prevent
site bleeding.
A Growing Problem
AF involves many patients and it’s often
progressive - from rare episodes to more
persistent or permanent conditions.
Ablation for Atrial Fibrillation
Modern Therapy for the Most
Common Arrhythmias
2016 CHI Memorial Heart Report 7
Antiarrhythmic drugs and cardioversion should be
considered in symptomatic patients, but can often
be ineffective and limited by patient comorbidities
like CAD, hypertension, obesity, sleep apnea, CHF,
COPD and renal failure.
“Although labor intensive and associated with
some procedural and periprocedural risks,
radiofrequency ablation can be a safe and
effective treatment for symptomatic AF patients
in whom AA drugs have failed,”says Dr. Shander.
“The earlier we see these patients, the more likely
we are to have successful outcomes.”
8. 8 Impacting Lives with Advanced Cardiac Care
According to the
American Heart
Association, about 5.7
million adults in the
United States suffer
from heart failure,
a complex health
condition that causes
tiredness, leg swelling,
shortness of breath, and
greatly affects quality of life.
It’s also associated with a high
mortality rate. Statistics show that
each year about 870,000 new cases
are diagnosed and about 50% of those
diagnosed will die within five years.
To combat the effects of heart failure, CHI
Memorial, in coordination with The Chattanooga
Heart Institute, developed the heart failure
program that has consistently improved
readmission rates for people with the condition
since its inception in 2011.
“In 2010, the readmission rate for people with
heart failure was near 21% before the program
was developed. Since then we’ve seen dramatic
declines and are on track to be less than 10% in
2015,”says Allen Atchley, Jr., M.D., cardiologist
and medical director of CHI Memorial’s heart
failure program.“We have implemented a
process that focuses on quality and evidence
based medical therapy, the transition to
outpatient care, and communication with
primary care providers which has simultaneously
stabilized and even slightly improved hospital
length of stay while reducing our heart failure
mortality rates.”
Knowledge is Power
The program is designed to empower patients
to take better care of their health through
education about heart failure and its necessary
medications; consistent and timely follow up to
ensure medication compliance; and thorough
communication with the patient’s primary care
physician after discharge. The transition of care
from hospital to home is a critical time that has
a substantial impact on whether or not that
patient will return.
The heart failure program has included nearly
1,700 patients since October 2012, and currently
involves more than 500 patients each year.
Dr. Atchley credits the success of the program
to the nursing team led by Emily Gunn, who
ultimately educates patients, maintains close
contact after discharge to answer questions or
concerns, and helps remove barriers that may
hinder a patient from seeing their physician or
taking their medications.
Managing Heart Failure
Readmission Rates Decreasing Year
Over Year
8 Impacting Lives with Advanced Cardiac Care
9. 2016 CHI Memorial Heart Report 9
“This program was built on solid medical evidence and encouraged by a supportive
administration, but it’s ultimately the dedicated team of nurses that are the driving
force,”says Dr. Atchley.“It’s a prime example of a multidisciplinary team that
includes the physician, nurses, and primary care working together for each
patients’good. These are simple concepts, but ones that require focused
intention to be successful.”
Connecting Patients with Critical Resources
Following patients after they leave the hospital can be difficult, but it’s a
crucial part of providing excellent cardiac care. CHI Memorial connects with
patients and helps manage their health conditions through TAVHealth, the
leading cloud-based platform that connects care providers to community
resources and support services. We know these services are critical in helping
patients transition from inpatient to outpatient to home with increasingly
successful outcomes.
Based on each person’s personal story and barriers, we develop a network
of resources that contribute to positive outcomes. These connections support
patients from outside the health system and allow physicians to deliver better
outcomes from within.
10. 10 Impacting Lives with Advanced Cardiac Care
To date, CHI Memorial has treated more than 100
patients with TAVR.
In November 2015, CHI Memorial’s TAVR (transcatheter aortic valve
replacement) team performed its 100th procedure. Bringing together the
talents of interventional cardiology, cardiothoracic surgery, radiology and
cardiac anesthesia, these experts continue to refine the minimally invasive
techniques that are changing the approach to valve replacement. Several
changes in the way TAVR is performed have meant more patients are now
qualified to receive the lifesaving procedure.
TAVR is for select patients with severe symptomatic aortic stenosis (narrowing
of the aortic valve opening) and other valvular issues who are not candidates for
traditional open heart surgery or are high-risk operable candidates. Multiple medical
and surgical issues are considered when evaluating a patient as a possible recipient of
the TAVR valve.
“When TAVR was first introduced, it was only approved for patients considered
inoperable. Changes to the requirements now mean that patients with valve disease
who are deemed high risk may also be appropriate,”says Jennifer Welch, RN, CHI
Memorial’s valve program coordinator.“This has opened the door for more patients to
be evaluated by the heart valve clinic and valve team physicians.”
The smaller retroflex valve delivery system for TAVR that was approved in June 2014
often requires no surgical incision – it can be placed through a small puncture site in
the groin. It’s similar to heart catheterization but with a slightly larger catheter, and a
closure device is used post-operatively to close the artery when the delivery system is
removed. This has reduced the need for heavy sedation, mechanical ventilation and the
potential for hospital-acquired infections.
Pioneering Treatment for Heart
Valve Replacement
10 Impacting Lives with Advanced Cardiac Care
11. 2016 CHI Memorial Heart Report 11
Qualified patients may also receive monitored anesthesia care (MAC).
This method allows the use of sedation and local anesthesia where
patients do not need intubation but are completely asleep throughout
the procedure. It has reduced some patients’overall time spent from
admission to discharge to 33 hours.
CHI Memorial is the only hospital in the Chattanooga area chosen as a
site for the use of the TAVR valve. In October of 2011, when Memorial
was selected, it was one of only 24 hospitals nationwide chosen to
use this newly FDA approved device. Since the program began in
December 2011, 113 patients have received TAVR. Sixty-six of those
patients have undergone the procedure since July 2014 and the
introduction of the smaller delivery system.
“The lower profile of the newest TAVR delivery systems allows us to use
the transfemoral route on more high risk candidates, and we expect up
to 90% of our patients will be treated by this approach. Most patients
avoid intubation and are discharged the following day with a marked
improvement in exercise tolerance and improved survival,”says
Mark Thel, M.D., cardiologist at The Chattanooga Heart Institute and
member of the TAVR team.“When the FDA approves this procedure for
people with intermediate risk, the number of people who will benefit
from the procedure will expand exponentially. We’re excited about
the opportunity to bring this revolutionary alternative to open valve
replacement to more people than ever before.”
TAVR Stats
After July 2014 with
new delivery system:
84.4% deployed transfemorally
7.6% deployed transapically
7.6% deployed transaortically
TAVR Stats
Before the smaller
delivery system was
approved in June 2014:
44% deployed transfemorally
28% deployed transapically
28% deployed transaortically
12. 12 Impacting Lives with Advanced Cardiac Care
CHI Memorial remains
at the forefront of the
latest cardiac-related
technologies and
techniques. The gold
standard of diagnosing
and treating coronary
heart disease is cardiac
catheterization. This can be
done through the femoral
artery in the leg, or in a newer
approach, called transradial
catheterization, through the artery in
the wrist and then threaded to the heart.
“Transradial coronary angiography
and intervention offer improved
patient comfort, decreased
access-site complications, and
potentially decreased costs
– all without compromising
procedural success or
outcomes in most patients,”
says Brian Negus, M.D.,
interventional cardiologist
with The Chattanooga Heart
Institute at CHI Memorial.“A
few years ago, less than 10%
of catheterizations performed here were
done transradially, but our most recent
data showed that 43% used this method.
As physicians become more comfortable
with the technology, we’re likely to see a
continued increase because of the benefits it
affords patients.”
Radial artery occlusion and radial artery
spasm are two potential risks associated
with transradial catheterization but are
not common. The benefits include a
decreased risk of bleeding and faster
and more comfortable recovery. Patients
can often sit, stand and eat immediately
following catheterization, increasing patient
satisfaction. Because the radial artery is small
and superficial, it’s easily compressible, and
bleeding complications associated with
radial arterial access are rare.
Transradial catheterization may also
reduce procedural costs because of fewer
complications and shorter hospitals stays.
Same-day discharge is possible after
coronary intervention, and combined with
less staffing needed for patient care, costs
can be significantly reduced.
Faster, Safer, Less Expensive
Cardiac Catheterization Continues to
Evolve
12 Impacting Lives with Advanced Cardiac Care
13. 2016 CHI Memorial Heart Report 13
The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and
Systems) survey is the first national, standardized, publicly reported survey
of patients’perspectives of hospital care. HCAHPS is designed to produce
data about patients’perspectives on their care that allow objective and
meaningful comparisons; create new incentives for hospitals to improve
quality care; and enhance accountability in healthcare by increasing
transparency of quality outcomes. The data below represents FY2015.
Further improvements in patient satisfaction scores have been seen in the
most recently collected data.
Solid Outcomes,
Satisfied Patients
Overall Hospital
Rating for Cardiac Care
areas combined:
84.6% | 94th percentile
Short Stay Unit (primarily provides care
for patients who have had arteriograms):
89.1% | 96th percentile
5 North (cares for a variety of cardiac patients
and for open heart patient post-ICU):
83.2% | 93rd percentile
7 North (cares for a variety of cardiac patients,
specifically heart failure patients):
82.4% | 93rd percentile
Overall Hospital
Patient Satisfaction:
85% | 93rd percentile
Patient Advocacy
(Likelihood to Recommend):
89.7% | 96th percentile
Short Stay Unit: 92.8% | 96th percentile
5 North: 87.8% | 92nd percentile
7 North: 88.8% | 94th percentile
14. 14 Impacting Lives with Advanced Cardiac Care14 Impacting Lives with Advanced Cardiac Care
Over the past several years, CHI Memorial has experienced tremendous growth.
In June 2014, CHI Memorial proudly opened the newly constructed Guerry
Heart and Vascular Center. The center, named in honor of the Alexander
Guerry family, boasts 300,000 square-feet of space including a seven-story
patient tower, 96 patient rooms, seven cardiac catheterization rooms, a short
stay unit, and St. Anne’s Chapel. The center also offers a healing garden
and special quiet patient waiting areas for loved ones who are staying with
patients.
These modern facilities – fully equipped with the most advanced cardiac
capabilities – allow us to be at the forefront of evolving patient care. This
includes state-of-the-art technology like the hybrid operating suite, combining
the latest surgical innovations with the equipment and personnel necessary for
performing advanced open-heart procedures. This flexibility and versatility means
our surgeons can easily address unexpected complications and emergencies,
providing the best possible patient care.
Rehabilitation and Cardiac Management
Cardiac rehabilitation programs are a crucial part of the recovery process after a cardiac event.
Truly great care can’t end with a procedure. Our team offers support and guidance to people living
with heart disease and their families. Cardiac rehab programs are proven to significantly increase
chances of survival, reduce recurrence and improve quality of life.
CHI Memorial offers several clinics and programs that help patients prevent heart incidents and
lower their risk factors. These include the heart failure program, healthy lung program, amiodarone
clinic, anticoagulation management and lipid management.
Reconstructing Care
15. 2016 CHI Memorial Heart Report 15
Joint Operating Committee
Leadership
Allen Atchley, M.D.
Robert Berglund, M.D.
Rob Headrick, M.D.
Stephen Monroe, M.D.
Richard Morrison, M.D.
William Warren, M.D.
David Wendt, M.D.
James Zellner, M.D.
Larry Schumacher, chief executive
officer
Paul Farmer, president, The
Chattanooga Heart Institute
Troy Hammett, CFO, senior vice
president, finance
Rhonda Poulson, CNO, vice
president, clinical operations
Diona Brown, vice president,
cardiovascular services
About CHI Memorial
CHI Memorial is a not-for-profit, faith-based healthcare organization dedicated to the healing
ministry of the Church. Founded by the Sisters of Charity of Nazareth and strengthened as
part of Catholic Health Initiatives, it offers a continuum of care including preventative, primary
and acute hospital care, as well as cancer and cardiac care, orthopedic and rehabilitation
services. CHI Memorial is a regional referral center of choice with 3,400 associates and more
than 700 affiliated physicians providing health care throughout Southeast Tennessee, North
Georgia and Northwest Alabama.
The 405-bed hospital system includes the advanced Guerry Heart & Vascular Center, complete
with a cardiovascular intensive care unit, coronary care unit, clinical decision/chest pain
observation unit and short stay. Cardiac telemetry capabilities are available at both CHI
Memorial and CHI Memorial Hospital Hixson.
To learn more, visit www.memorial.org.
16. memorial.org/heart | Follow us on Twitter@CHI_Memorial | Follow us on Facebook@CHIMemorial | Watch us on YouTube/MemorialChattanooga
