16-163 chi memorial heart report 2016_web

Impacting Lives with Advanced Cardiac Care CHI Memorial Heart Report 2016

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

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 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


CHI Memorial

CHI Memorial

HixsonInpatient 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 VolumesElectrophysiology Diagnostic 579

Electrophysiology Interventional 1,988

Ablations 387

ICD Insertions 397

Pacer Insertions 508

FY2015 ACC/Cardiac Cath/PCIDiagnostic 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 12/31/2015Edwards CoreValve 50 CY2015

FY2015 Cardiac ImagingEchocardiograms 13,044

Cardiac Computed Tomography Scans 1,567

Nuclear Cardiology 4,375

Stress Tests 1,241

Vascular 8,817


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 AwardThis 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


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 SolutionsBecause 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


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.”


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



“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.


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



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


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



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 Impacting Lives with Advanced Cardiac Care 14 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


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 MemorialCHI 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.

memorial.org/heart | Follow us on Twitter@CHI_Memorial | Follow us on Facebook@CHIMemorial | Watch us on YouTube/MemorialChattanooga

16-163 chi memorial heart report 2016_web

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