An Inside Look at Cardiovascular Research at the Intermountain Heart Institute

The Intermountain Heart Institute, located in the middle of the Salt Lake Valley in Utah, is part of Intermountain Healthcare’s flagship hospital, Intermountain Medical Center. Intermountain Heart Institute sees over 20,000 patients annually from around the country, providing regular clinical care, diagnostic tests, interventional procedures, and cardiovascular surgeries. Heart Institute physicians also staff satellite offices and clinics in three other hospitals within the region: Alta View Hospital, LDS Hospital, and Riverton Hospital. 

The Intermountain Heart Institute is comprised of a group of over 45 heart specialists, including six cardiothoracic surgeons, 15 consultative cardiologists, seven heart rhythm specialists, four heart failure specialists, six CV hospitalists, and four dedicated CV intensivists. Cardiovascular specialty programs within the Heart Institute include the Aortic Disease Center, Genetic Heart Disease Program, Coronary Heart Disease Program, Cardiothoracic Surgery Program, Heart Failure, Transplant and Artificial Heart Program, Peripheral Vascular Disease Program, Heart Rhythm Program, and the Heart Valve and Structural Heart Disease Program.

Donald L. Lappé, MD, FACC, FAHA, Chairman of the Cardiovascular Department, has identified the following four healthcare dimensions that frame all of our core strategies to improve the delivery of care and enhance the patient experience. These include: Advanced Care, Coordinated Care, Personalized Care, and Responsive Care. By focusing on these dimensions and through the collaborative efforts of our clinical/hospital teams and specialty programs, we have achieved national recognition in the following areas:

• Low hospital readmission rates and mortality reduction among heart attack patients 
• Catheter-based approaches in heart valve repair that provide alternatives to potentially more complicated open-heart surgery 
• Heart transplantation and LVAD implantation and management   
• Treatment of the largest number of patients in the Intermountain West who suffer from abnormalities in the electrical system of the heart
• Recognition in 2013 as the number one major regional referral center for patients with advanced heart problems.   

Beyond treating symptomatic patients, the Intermountain Heart Institute is proactive in reducing cardiovascular risk in the Salt Lake community. Beginning in 2013, the “My Heart Challenge” is a contest where contestants attempt in 100 days to improve their physical activity and eating habits. Contestants work with a dietitian, exercise trainer, therapist, and others to help them identify the areas they need to improve. The clinical team also provides an exercise stress test before and after the contest to measure a change in their cardiovascular health. The Heart Institute also sponsors a free annual Heart Fair that includes health screenings, cooking demonstrations, and seminars available to the public. Finally, our annual 5K Fun Run, which has been held each of the last 11 years in honor of heart disease survivors, promotes ongoing quality of life through physical activity, creating new friendships, and fun. 

Cardiovascular Research

Our cardiovascular research team is comprised of nationally recognized and published physicians, epidemiologists, and advanced practice clinicians, and is supported by dedicated statisticians, highly trained research coordinators, and regulatory specialists. Discussing the importance of research, Associate Chief of Cardiology and Director of Cardiovascular Research, Jeffrey L. Anderson, MD, stated, “Research is the lifeblood of medicine. It drives our progress to better understand, prevent, diagnose, and treat cardiovascular disease as well as to achieve healthier living and lifestyle goals.” Over the past two years, we have presented or contributed over 100 abstracts at both national and international conferences of major cardiovascular organizations, as well as published over 80 original manuscripts and book chapters. The Intermountain Heart Institute Cardiovascular Research Team is currently working on over 100 individual research projects aligned with our research mission to:

• Improve our understanding of the mechanisms of cardiovascular disease
• Discover improved ways to predict, detect, treat, and cure cardiovascular disease
• Apply new knowledge to clinical practice to shape prevention and treatment solutions individualized to each unique patient.

Reflective of this mission, Benjamin D. Horne, PhD, Director of Cardiovascular and Genetic Epidemiology, states: “What we do here provides new discoveries that can be used almost immediately. When community members see we care enough to learn how to provide better care for their health through research, they have a lot of confidence they will receive the best care.” A.G. Kfoury, MD, Director of Heart Failure and Transplant, adds, “Because Intermountain has stayed involved in the latest research, we’ve been able to deliver evidence-based medicine to our heart patients. This type of medicine is a key driver of high-quality, low-cost care and is made possible today due to decades of research.”

The need for ongoing strong collaboration and unity within the Intermountain Heart Institute sub-specialties for common treatment goals and research is boldly stated by John D. Day, MD, Director of Heart Rhythm Specialists: “To be at the forefront of medical care requires a hospital that understands how critically important research is. Our goal is to discover the breakthroughs that will benefit patients within our own community, as well as patients throughout the world.” This is echoed by T. Jared Bunch, MD, Director of Electrophysiology Research: “Research is critical for the Intermountain Heart Institute as well as our healthcare system as a whole. It provides us a means to examine our current approaches and to innovate and share with other systems in order to shape the future of medicine.”  

The Intermountain Heart Institute sponsors its own investigator-initiated studies, such as RAD HF (NCT01887353 on ClinicalTrials.gov), and also collaborates with other academic centers, consortiums, as well as industry partners, for single and multicenter large-scale trials such as ACUITY (NCT00955708), HeartLight (NCT01456000), LSS 4-SITE (NCT01596595), CABANA (NCT00911508), Leadless II (NCT02030418), the MagnaSafe Registry (NCT00907361), and NAVIGATE ESUS (NCT02313909).

Housed at LDS Hospital near downtown Salt Lake City is one of the world’s largest cardiovascular DNA and plasma bank repositories, overseen by John F. Carlquist, PhD, Director of the Intermountain Heart Institute Genetics and DNA Lab. Initiated over 20 years ago by visionaries J. Brent Muhlestein, MD, Jeffrey L. Anderson, MD, and John F. Carlquist, PhD, it includes samples from over 25,000 individuals who have consented to the INtermountain Healthcare Biological Samples Collection Project and Investigational REgistry for the Ongoing Study of Disease Origin, Progression and Treatment (Intermountain INSPIRE Registry). Additionally, each subject has been followed electronically using Intermountain’s Enterprise Data Warehouse, with over 80 billion rows of data and 9,000 data tables being added since 1993. This unprecedented combination of patient records and DNA samples, paired with the clinical, epidemiological, and biological expertise of our scientists, forms the basis for the power and uniqueness of the research resource at our facility.

The Intermountain Heart Institute Cardiovascular Research Department is directed by Dr. Anderson and co-directed by Dr. Muhlestein. Electrophysiology research partners include Dr. Bunch and Dr. Michael Cutler. Additionally, the research team includes: two advanced practice clinicians, Victoria Jacobs, APRN and Viet Le, MPAS, PA-C; Stacey K. Knight, PhD, MStat (Genetic Epidemiology), and Heidi May, PhD (Epidemiology); Ray McCubrey, MStat; Fidela Moreno, MD; 4 regulatory staff members; and over 15 certified research coordinators.

We are actively working to establish collaborations with other academic centers and pharmaceutical entities, pooling our data to increase the power of our observations. We hope to expand upon our current work in improving risk stratification algorithms. It is our goal to advance the knowledge of the interplay of genetics, proteomics, and micro-RNA for the prediction, detection, and etiologies of disease as well as potentially find novel ways to treat and cure disease.