Inova’s team-based care delivers coordinated and comprehensive expertise
Two patients share their experience on how Inova’s collaborative team-based multidisciplinary care delivered lifesaving results
By WP Creative Group
May 21, 2024
This spring, Apryl Binder will celebrate the five-year anniversary of her successful heart transplant.
To mark the occasion, Binder likes to think of all she has to look forward to. The Virginia resident and mother of three is pursuing a degree in psychology, and this May, she’ll watch her youngest daughter graduate from high school.
Thanks to the cardiovascular experts at Inova Schar Heart and Vascular, Binder can experience these special moments and achievements without concerns of illness weighing her down.
“I was very sick before I had the heart transplant,” Binder recalls. “When your heart’s not working well, you experience all-over body fatigue. Now, I feel good. I feel normal. I’ve gotten my life back.”
The heart is arguably one of the most vital organs in the human body – and one of the most complex. For this reason, Inova Schar Heart and Vascular involves the perspective of multiple medical specialties to deliver comprehensive care of cardiac, vascular and cardiopulmonary conditions.
“What distinguishes us from many other centers around the country is our commitment to offering an integrated approach to care,” said Behnam Tehrani, M.D., who serves as Co-Director of the cardiac catheterization laboratories at Inova Fairfax Medical Campus and Co-Director of Inova Schar Heart and Vascular Cardiogenic Shock Program. “Our specialists collaborate across areas of expertise to provide a unified and systematic approach that is based on proven clinical best practices.”
Inova’s collaborative team-based approach also saved the life of John Harrity, a D.C.-based lawyer who experienced a complex heart attack while playing basketball eight years ago.
When Harrity arrived at Inova that afternoon, it was the quick decision making of Inova’s Cardiogenic Shock Team – a group of interventional cardiologists, cardiac surgeons, advanced heart failure specialists and intensivists – that stabilized him when his condition went from bad to worse.
“I can say from experience, if you have a heart issue in the DC area, go to Inova. They are really outstanding.”
– John Harrity, heart attack survivor and Inova patient
“Everything happened really fast, and I was unconscious for a lot of the heavy lifting, but I know I’m here today because of their teamwork,” said Harrity. “I can say from experience, if you have a heart issue in the DC area, go to Inova. They are outstanding.”
Binder and Harrity represent just two of the thousands of patients with heart disease treated at Inova each year. Their stories are exemplary of the innovative team-based approach, cutting-edge medical research and outstanding patient outcomes that have placed Inova among the nation’s top hospitals.
“These patients’ experience embodies the mission of Inova to provide world-class healthcare – every time, every touch,” said Christopher M. O’Connor, M.D., President of Inova Schar Heart and Vascular. “We have been on the forefront of leveraging a wide range of cardiovascular and cardiopulmonary expertise using multidisciplinary care teams as a cornerstone of care. Close collaboration across clinical areas enables our teams to develop a course of treatment to address complex conditions that impact multiple organs and underlying health conditions that affect each patient. This approach has set new standards of excellence in the comprehensive services we deliver for our patients.”
Inova provides lifelong care after heart transplant
In September 2017, Apryl Binder was arriving at a friend’s house for a night of bunco when she started feeling fatigued, with radiating pain to her jaw.
A friend drove Binder to Inova Loudoun Hospital, where emergency room doctors quickly realized she was experiencing a heart attack with a complicated underlying cause.
She underwent a cardiac catheterization procedure that assesses for potential cholesterol-related blockages in the coronary arteries and also measures the pressures in the heart chambers. In Binder’s case, it was determined she was experiencing a spontaneous coronary artery dissection, or SCAD.
In this condition, a tear suddenly occurs within the layers of one or more of the coronary arteries, which can dramatically impair blood flow to the heart muscle, leading to a potentially fatal heart attack. SCAD most commonly affects women in their 40s and 50s.
“Women have been historically under-treated in the cardiovascular disease space for a number of reasons,” said Mitchell Psotka, M.D., who specializes in cardiovascular disease and advanced heart failure and transplant cardiology at Inova. “One is long standing inequities in care between men and women. Another is that heart disease presents differently in women than in men. For instance, the classic chest pain with a heart attack doesn’t tend to happen as much in women. They tend to have other symptoms such as fatigue and nausea.”
Inova offers a women’s cardiovascular health program, led by Garima Sharma, M.D., a nationally recognized expert in women’s cardiovascular health. The program is available at select Inova Cardiology and Virginia Heart outpatient offices across Northern Virginia and offers specialized expertise and an understanding of how women’s heart disease presents differently.
After being diagnosed at Inova Loudoun, Binder was flown to Inova Fairfax Medical Campus to have triple bypass surgery. “I will be forever grateful for the doctor in the emergency room who correctly diagnosed the type of heart attack I was having,” she said.
Binder’s triple bypass was performed by Eric Sarin, M.D., a cardiovascular surgeon and Co-Director of the Inova Structural Heart Program. He used a blood vessel from her leg to create another way for blood to reach her heart.
Two weeks later, she experienced compartment syndrome, a rare complication of cardiac surgery that affects the lower limbs. Again, Inova’s 24/7 multidisciplinary team of specialists were able to diagnose and treat the condition quickly. Vascular surgeon Reagan Quan, M.D., who leads vascular and endovascular surgery at Inova Loudoun Hospital, performed a fasciotomy on Binder’s right leg to relieve built-up pressure.
When Binder left the hospital in October, she remained under the watchful guidance of Psotka for months. As time went on and it became clear that Binder’s heart would not fully heal from the earlier damage resulting from the coronary artery tear, it was Psotka who recommended a heart transplant.
“Dr. Psotka actually took the time to meet with my daughters before I had the heart transplant… to explain it in a very calm and non-scary way.”
– Apryl Binder, heart attack survivor and Inova patient
“When it comes to more advanced heart failure therapies such as a transplant, that is really the epitome of team-based care,” said Psotka. “We are a very large team at Inova, which is what it takes to provide the nuanced and complicated care to not only have a transplant, but then to live many, many years afterwards. This is basically a lifelong marriage between us and the patients.”
The team in charge of Binder’s transplant and recovery included not only cardiac surgeon Ramesh Singh, M.D., but a number of nurses, advanced practice providers, palliative care team members and pharmacists with expertise in transplant care.
“As a physician it is very fulfilling to be a part of such multidimensional care and to know that we’re doing absolutely everything that we can for our patients.”
– Mitchell Psotka, M.D., Inova specialist in cardiovascular disease and advanced heart failure and transplant cardiology
“Our team has meetings once a week where we all get together and talk about our patients and what is best for them,” Psotka added. “We work through each of the issues and then we all go see the patients in person as well. As a physician it is very fulfilling to be a part of such multidimensional care and to know that we’re doing absolutely everything that we can for our patients.”
Just as important as a doctor’s expertise, is their ability to show compassion to a patient and their families. In the weeks before the procedure, Binder says Psotka went the extra mile to put the minds of her daughters at ease.
“Dr. Psotka actually took the time to meet with my daughters before I had the heart transplant, because they were all freaked out,” she said. “He was able to explain it in a very calm and non-scary way. I don’t know if a lot of doctors would’ve done that.”
A routine evening basketball game ended with a 911 call
Since his 30s, John Harrity has been striving for a very specific goal: to live healthy to at least 100 years old.
“I don’t drink or smoke,” he said. “I exercise at least seven times a week, and I follow a very strict, healthy diet. So that afternoon, when I started getting some unusual shortness of breath, a heart attack was not on my mind. I didn’t know healthy people could have a heart attack.”
Still, Harrity says he could tell something wasn’t right. He ended the basketball game he’d been playing with friends, and the last thing he remembers is asking them to call 911.
The 49-year-old husband, father and lawyer had suffered a complex heart attack, and after being rushed to Inova Fairfax Medical Campus, he had a second cardiac arrest and deteriorated quickly into cardiogenic shock.
“Cardiogenic shock is the end stage of heart failure, either due to a heart attack or a chronically weakened heart. These patients typically have only a 40% to 60% chance of survival,” said Tehrani. “Swift and well-coordinated intervention is critical for optimizing outcomes.”
Fortunately, with the specialists who make up Inova’s Cardiogenic Shock Team, Harrity was in good hands. In these types of emergency situations, as an interventional cardiologist stabilizes the patient, that physician also has access to a cardiac surgeon, an advanced heart failure specialist and a cardiovascular critical care physician.
“The cardiovascular critical care specialist is thinking about how to stabilize all the organ systems impacted, the advanced heart failure specialist is contemplating the patient’s suitability for mechanical circulatory support devices or heart transplant, and the cardiac surgeon is weighing options about how to best place support devices surgically if needed,” Tehrani explained. “By having these specialists from different disciplines, we are able to provide the patient the best of our combined knowledge with the goal to provide cutting edge and compassionate care.”
John Harrity, in recovery at Inova Schar Heart and Vascular
For Harrity, the shock team chose a support device called extracorporeal membrane oxygenation (ECMO), which provided cardiac and respiratory support when his heart and lungs were unable to sustain life.
Not only was Inova among the first hospitals in the country to have a formal cardiogenic shock program, the health system was also the first to publish data around this innovative program in the Journal of American College of Cardiology in 2019. While the national survival rate for cardiogenic shock hovers at 50%, Inova’s cardiogenic shock survival rate has consistently exceeded 70%, even as its number of cases have tripled. Inova now serves as a regional hub for treating cardiogenic shock from a network of more than 30 hospitals using its care protocols. In 2023, Inova’s survival rate increased to 82%.
“Our program has not only influenced care locally, but it’s now been reflected in the clinical guidelines, and that is something that we’re very proud of here at Inova.”
– Behnam Tehrani, M.D., Co-Director of the cardiac catheterization laboratories at Inova Fairfax Medical Campus and Co-Director of Inova Schar Heart and Vascular Cardiogenic Shock Program
“Findings from our cardiogenic shock program helped inform the 2022 American Heart Association guidelines to now provide a class 2A level evidence recommendation for implementation of cardiogenic shock teams for patients afflicted with this condition,” said Tehrani.
Months later, when Harrity was awake and able to understand what had happened to him, he had one question for his doctors: would this impact his goal of living healthy to 100? His team of cardiologists and the advanced care doctors at Inova were happy to report that goal is still achievable.
Learn more about world-class healthcare provided at Inova Schar Heart and Vascular Institute.
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