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Wednesday, October 5, 2022
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Medical: Steady progress seen in battling heart disease and cancer

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Heart disease is the leading cause of death in North Carolina. Researchers and medical professionals are dedicated to changing that.

The numbers are staggering. One person dies of cardiovascular disease every 34 seconds in the United States, according to Centers for Disease Control and Prevention. And about 800,000 people — about 605,000 for the first time — suffer a heart attack each year. Almost 20% of them don’t even realize it happened, though damage is done. 

Heart disease killed about 700,000 U.S. residents in 2020, making it the leading cause of death for men, women and people of most racial and ethnic groups, according to CDC. The numbers are slightly better for North Carolina, where its heart-disease death rate fell to No. 31 in 2019 nationally from No. 24 in 2015, according to Justus-Warren Heart Disease and Stroke Prevention Task Force research, which was completed last year using the most- recent data. 

Still, heart disease and stroke are the No. 1 and No. 5, respectively, causes of death in North Carolina, according to CDC. The Justus-Warren study also found heart disease and strokes were the highest diagnostic categories when it came to hospItalization charges and Medicaid expenditures. These costs, along with the number of heart-disease and stroke deaths, hit the state’s minority populations the hardest. 

The state’s health care systems and research centers are striking back. They’re creating solutions and developing technologies to combat heart disease. Their goals are lowering death rates, relieving symptoms and acting fast in matters that are often life or death. 

Heart failure — when the heart can’t pump enough blood to meet the body’s needs — affects about 6.2 million adults nationwide. Treatments depend on its severity, but they include reducing sodium intake through diet, increasing exercise, and implanting a defibrillator or pacemaker. While these efforts can strengthen a patient’s heart, their success in reducing symptoms may be limited. 

The search for better heart failure treatments led Cone Health researchers to participate in BeAT-HF, a national clinical trial of BAROTISM NEO, a device manufactured by CVRx, the study’s sponsor. The device sends electrical pulses to the patient’s neck, where cells sense how blood is moving through the carotid arteries. Those cells deliver information to the brain, which controls production of stress hormones that impact heart function. The device reduces heart-failure symptoms, which include shortness of breath, fatigue, weakness, swelling, chest pain and persistent coughing, by altering those signals. The device also allows patients to increase physical activity, a key factor in strengthening the heart and further preventing heart failure. 

Cone Health was one of the clinical trial’s largest enrollers. As part of the trial, Cone Health Drs. Vance Brabham and James Allred were among the first physicians to install a BAROTISM NEO in patients and the first to implant the device using the less invasive BATwire technique. 

Patients who received a BAROTISM NEO have shown an 83% improvement in their capacity for exercise within six months, according to Cone Health. And 78% reported a significantly lower impact of symptoms in their daily lives, while 80% had a reduction in their hospitalization.

Dr. Sun Moon Kim is an interventional and structural cardiologist with Pinehurst-based FirstHealth of the Carolinas and director of its Reid Heart Center Valve Clinic. He studies technologies that provide options for patients who are not good candidates for open-heart surgery. This shift in heart care isn’t necessarily new. He says the hospital has been doing minimally invasive transcatheter aortic valve replacements since 2015. But it also has added more recent innovations such as Watchman. It involves placing a device that seals off the left atrial appendage, where the vast majority of clots form. Once it’s isolated and the risk of clots is lowered, the patient’s risk of having a stroke falls, too.

CarolinaEast Medical Center in New Bern is one of the only hospitals in eastern North Carolina performing many of the advanced heart procedures.

Kim and other FirstHealth cardiologists began using the minimally invasive Watchman procedure in October as a solution for those with atrial fibrillation — an irregular heartbeat that can cause blood clots. The standard treatment for atrial fibrillation has been prescribing blood thinners long term. But there has been no good option for a-fib patients who take certain medications or suffer from other certain medication conditions. The Watchman offers them a solution. “Our focus has shifted from doing everything the same way for every single patient,” he says. “Now the direction has been going toward individualized care.” 

Moving forward, Kim sees more minimally invasive procedures being used, including for patients outside of the high-risk category. But more than that, a year from now he expects heart care will become even more individualized for patients. This means taking a more holistic approach toward each individual’s health concerns and working as a team with
other medical professionals. “We’re going to try to continue to push the boundaries of what community medicine can provide,” he says. “We’re going to try to provide comprehensive care more than anything.” 

Some of the state’s smaller health care systems are marking milestones this year. UNC Health Southeastern, for example, was one of 81 hospitals nationwide to receive the American College of Cardiology’s NCDR Chest Pain — MI Registry Gold Performance Achievement Award in May. It places the health system among the top-performing hospitals for treating heart attack patients. 

UNC Health Southeastern had to meet top levels of performance indicators and be one of the top performers among all states for a longer period of time in order to receive
the award. It had been recognized by American College of Cardiology in 2020 and 2021.

CarolinaEast Health System completed its 6,000th open heart surgery, 100th transcatheter aortic valve replacement procedure and 200th Watchman procedure in 2022.  Michael Smith, who was named the health care system’s president and CEO  in June, says its CarolinaEast Medical Center in New Bern is one of the only hospitals in eastern North Carolina that does these types of heart procedures. “We have remarkable heart care here,” he says. “It’s a good place to have heart trouble. Our outcomes are really phenomenal.”

COMBATING CANCER
Health care systems, doctors and researchers are taking on North Carolina’s No. 2 cause of death with new treatments and technologies.

Cancer prevention takes many forms. But for Windy Christy, knowledge is No. 1.

A physician assistant at UNC Health Southeastern’s Gibson Cancer Center, Christy says between 5% and 10% of all cancers are thought to begin with mutations in certain genes. So, screening people to see if they carry hereditary cancer syndromes is an important first step.

Christy enrolled in a six-month long City of Hope Intensive Course in Cancer Risk Assessment, which helped her better understand the needs of cancer risk assessment and genetic testing in and around Lumberton, home to Gibson Cancer Center. She found there was a need for cancer monitoring among those who were genetically predisposed to different cancers. 

Gibson Cancer Center expanded its offerings to meet the needs that Christy identified. “The High-Risk Screening and Genetic Testing Clinic provides cancer screening, chemo-prevention and genetic risk evaluation for individuals at increased risk of certain cancers,” she says. These patients are called cancer previvors — a person who takes action to reduce or eliminate a genetic condition before cancer develops. 

Cancer is the No. 2 cause of death in North Carolina. It caused about 150 deaths per 100,00 residents in 2020, according to Centers for Disease Control and Prevention. But the fight is on to change that. Health care systems statewide are improving their cancer care practices by developing technologies and assembling more efficient and comprehensive treatment plans, which improve patient experiences.

Cone Health in Greensboro launched Fuse Oncology last year. It’s an independent company whose sole purpose is developing technologies that solve cancer-care issues. BJ Sintay, Cone Health’s executive director of radiation oncology and chief physicist, is its CEO. Fuse raised $3 million in its first seed round with no additional funding from Cone Health. 

Sintay says Fuse’s goal is to accelerate the timeline of cancer care by improving the disjointed technology already being used in the field. “We know health care takes a lot of time — a lot longer than we want,” he says. “Especially in cancer care, delays cause additional problems and even death. We have a goal of making care happen within 24 hours of someone deciding to receive care. We can’t leave any provider or patient behind. We’ve got to get really innovative, and we have to say we know it’s hard and no one wants to bite into this challenging problem, but Fuse Oncology is doing it.” 

Fuse has already written software that tracks business and clinical information in radiation oncology practices, identifying missing documentation, incomplete tasks and orders, and wrong charges. Named S!GNAL, it’s already in use at Cone Health and two other health care systems.

Radiation oncology is a complex treatment process, and the medical reporting for it is so involved that popular electronic health record services, such as Epic and Cerner, won’t work with the patient files it generates. The FUSE team is working on a yet-to-be-named software that will provide medical professionals easier access to their patient’s charts and history without relying on faxed papers or other unwieldy systems.

Medical physicists at Cone Health are expanding the use of artificial intelligence technology. AI has been used to develop treatment plans through the health system’s Radiation Oncology Center for Innovation — ROCI — for several years.

Cone Health’s AI research began in 2015, when the technology was explored as a means to develop treatment plans for prostate cancer. “It was a basic type of case to test our initial hypothesis about whether this AI engine could produce comparable or better plans on a more consistent basis,” says Lane Hayes, ROCI oncology physicist who worked on the technology. “That project is what motivated us to continue.” 

AI proved successful. Hayes says when doctors were presented with treatment plans created by AI and plans created by doctors, about 90% chose an AI plan. From there they’ve explored using AI to develop treatment plans for other types of cancer, saving the most difficult regions for last: head and neck. 

Han Liu is a medical physicist with Cone Health and has been research-ing the use of AI to create cancer treatment plans since last year. He says researchers are now in the early stages of using the technology in clinical settings. “We’re trying to reduce planning time for head-neck [cancer] patients,” he says. “The head-and-neck area creates fast-growing tumors, so time can reduce the death rate.”

These projects, funded through ROCI by Cone Health, have life-saving effects and help patients feel calmer about their cancer diagnoses. “A study out of Cleveland Clinic showed that for every week we delay oncology care, it increases the chance of death anywhere from 1% to 3%,”

Sintay says. “Not only that, but the patients tell us about how they worry in these moments, when they’ve received diagnosis but cancer care hasn’t been initiated.”

Pinehurst-based FirstHealth of the Carolinas wants to speed up cancer treatment and make accessing it easier by putting all its services under one roof. It started work on its 120,000-square-foot cancer center in early 2020, and it expects construction on the four-story building will be complete by year’s end. Patient care is expected to begin in February. “It’s very unique to have this,” says Laura Kuzma, FirstHealth’s administrative director of oncology services. “It’s not often you find a facility this size with this many services in a small community like ours.” 

Kuzma says FirstHealth Cancer Services sees about 1,500 patients annually, and she expects that number to grow once the new cancer center opens, expanding treatment space and adding practitioners. It will be run by a multidisciplinary team that includes surgeons, medical directors and radiation oncologists. “So often we operate in our own individual areas, and that just holds us back from innovation, because you need all parts of the machine operating together,” she says. “It’s very moving and inspiring to me that all these folks are working together.”

 

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