YOUR HEART HEALTH
STATE-OF-THE-ART CARE, REHABILITATION, AND LIFESTYLE MANAGEMENT
By Margret Elson
Interventional Cardiology
 Until recently, a heart attack in Bozeman meant a flight to Billings for life-saving treatment. But an interventional cardiologist arrived in Bozeman in August 2005. To date, 113 local patients with blocked coronary arteries - including a 41-year-old man - were successfully treated at Bozeman Deaconess Hospital.
“Time is the most critical issue in treating myocardial infarction [blockage of one or more major heart arteries]. We hope to save lives by not having to transport to Billings,” said Dane Sobek, MD, interventional cardiologist who joined Blair Erb, MD, in his practice, Cardiology Consultants of Bozeman.
It takes up to two hours to airlift a patient to Billings. Treatment in Bozeman saves heart muscle making a significant difference in overall heart function and future quality of life.
Fellowship programs train approximately 500 interventional cardiologists a year. These specialists treat patients by “intervening” with tiny balloons to push plaque aside or small wire mesh tubes—stents—to support artery walls and keep arteries open. Percutaneous coronary intervention (PCI) is minimally invasive. It involves placing an arterial catheter in the groin. Dye is injected into the coronary arteries to find critical blockages. If an artery is significantly blocked it can be reopened with procedures called angioplasty and stenting. What’s more, if an artery is completely blocked, the procedure stops a heart attack in its tracks. Blood flow is restored to the dying heart muscle.
Bozeman Deaconess opened its $1.2 million, state-of-the-art Cath Lab in 2003. Since then, Erb has performed over 500 diagnostic catheterizations. Jennifer Kack, RN, manager of the Cath Lab, says that before Erb’s arrival, all these patients would have gone to Billings. She says patients want to stay home. “They don’t want to go to Billings. If they stay here, they can get results immediately and be with their family. Those who have acute cardiac emergencies save close to $8,000 in air transport costs,” she said.
Sobek, a Montana native, recently completed fellowship training in interventional cardiology at the University of Utah Medical Center in Salt Lake. He said he knows from experience how people in Montana can feel isolated from state-of-the-art medical care and he is very pleased to be able to develop the new interventional program with support from Erb and the staff at Bozeman Deaconess Hospital.
Cardiology Consultants of Bozeman is a comprehensive cardiology consultation practice. In addition to diagnosing and treating blocked arteries, Erb and Sobek treat patients with valvular disease, arrythmias and heart failure. Telemetry, treadmill, echocardiogram, and stress echo studies are performed in their new offices, located on the 3rd floor of the Highland Park 4 on the Bozeman Deaconess campus.
Encouraging Healthy Lifestyles
The Cardiac Pulmonary Rehabilitation and Adult Health & Wellness department at Bozeman Deaconess offers medically supervised programs for people with diagnosed illness, heart or breathing conditions along with adults who have lifestyle risk factors like obesity, high blood pressure, or a sedentary lifestyle.
“Our goal is to give people support and guidance to improve their overall wellness and quality of life,” said manager Terry Dutro, RN, BC, BSN. She and her multidisciplinary staff of five rely on evidence-based behavioral modification strategies to help patients make and stick to healthy lifestyle behavior changes. A physician’s referral is required for all services and every person gets an individualized, medically supervised program.
Cardiac Rehabilitation
It’s standard of care for people who have any type of heart event or heart mending procedure to participate in cardiac rehabilitation. (Heart events include heart attacks and congestive heart failure and heart mending procedures such as bypass surgery, angioplasty, stent, and valve surgeries.) Rehabilitation at this point, according to Dutro, is really secondary prevention. “After a cardiac intervention, a person has an opportunity to prevent disease progression and possibly reverse cardiovascular disease,” she said. “Metabolic and psychological benefits of rehabilitation reduce the risk of future cardiovascular events and/or death.”
Blair Erb, MD, of Cardiology Consultants of Bozeman, is medical director of the department. The rehab team, working closely with primary care physicians, tailors a program for each person. Everyone’s rehabilitation program involves a combination of education, exercise, and intensive cardiovascular risk reduction.
Pulmonary Rehabilitation
For those with chronic lung disease - bronchitis, asthma and emphysema - pulmonary rehabilitation improves perceived breathing capacity, increases strength and endurance, and helps people learn to manage the stress and anxiety caused by breathing problems. Medically supervised individual programs provide the tools, knowledge, and support needed to deal with chronic lung disease.
Promoting Health and Preventing Disease
Cardiovascular disease is the leading cause of death and disability in the United States. Evidence-based clinical practice guidelines for prevention intervention involve the development and refinement of lifestyle skills. They remain the foundation of risk factor intervention. That’s why a third focus in the department is management of risk factors. As Dutro puts it, it’s great to be able to put out fires, but it’s better to prevent them.
Lifestyle changes are difficult to make and just telling someone “go make a change” doesn’t do the trick. So for people at high risk for cardiovascular disease - those who are overweight, have high blood pressure or are smokers - a behavior-based wellness program can make a life saving difference.
“Our team focuses on people’s wellness and how they can better manage their cardiac or pulmonary condition,” said Dutro. The department tracks individual and program outcomes, getting high marks for clinical, behavioral, quality of life, and customer service outcomes. Collaboration and professional partnerships with hospital services such as diabetes education, physical rehabilitation, the sleep center, and pharmacy also factor into the department’s success.
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