RUSH Electrophysiology Outcomes Report

Electrophysiology OUTCOMES REPORT

In this podcast, Parik Sharma, MD, MPH, discusses His-bundle and conduction system pacing, which involves placing permanent leads anywhere along the AV conduction system to maintain biventricular pacing and synchrony. “We can decrease heart failure hospitalizations in patients with His-bundle pacing compared to right ventricular pacing,” he says. “And while right ventricular pacing can be associated with adverse clinical outcomes, such as cardiomyopathy, heart failure hospitalizations, atrial fibrillation and associated mortality, His-bundle pacing can essentially prevent a lot of them from occurring.”

Rounding at RUSH Podcast

Erica Engelstein, MD

Henry Huang, MD Director, Electrophysiology Fellowship

Timothy Larsen, DO

Jeremiah Wasserlauf, MD

Caitlin Boyak, NP

Paula Dunskis, CNS

Sonal Patel, PA-C

Alexander Mazur, MD

Providers

Clinical Site Reach and Expansion

of patients discharged in atrial or sinus rhythm post-procedure

99.4%

Afib Ablations

This data comes from two different National Cardiovascular Data Registries (NCDR) sponsored by the American College of Cardiology (ACC). Hospitals are required to participate in the LAAO registry and may opt into the Afib Ablation registry. These metrics help identify our quality outcomes and showcase our areas for opportunities to improve patient care. Using both national and regional benchmarks allow us to compare ourselves to hospitals with similar patient populations. Benchmarks are the median (or 50th percentile) unless otherwise noted. Jan 2022 – Dec 2022 National is all hospitals participating in Afib Ablation registry (n=168) Regional is all urban/suburban hospitals in Illinois (n=6) Volume: 336 procedures

Mortality Rate

(2) Major adverse event intra or post procedure prior to DC (includes stroke, PE, cardiac surgery, MI, cardiac arrest, TIA, and access site complications)

.6%

of patients are discharged in 1 day or less

93.5%

of patients discharge same day (with proven results of no greater complications or hospital visits post DC)

47.3%

Major complications (including bleeding, stroke & conversion to surgery)

2.5%

(3) non-device related readmissions

8.3%

(5) new events from discharge through 59 days post procedure (includes any bleeding, stroke or all cause readmission)

13.9%

of procedures successful (excluding canceled procedures).

92.1%

Mortality Rate

Initial surgery

Left Atrial Appendage Occlusion

(2) bleeding related events

5.5%

(n=51 because Oct. 2021-Sept. 2022)

Rhett Burgess had a feeling something wasn’t quite right. Even getting out of bed in the morning left the normally active, athletic baseball player short of breath. “I did not understand it and just felt so out of shape,” he recalls. The Rome, Georgia, nursing student’s suspicions were confirmed at his doctor’s office, where he learned that something was amiss in the lower left chamber of his heart. Tests showed his ejection fraction — a measurement of how much blood the left ventricle pumps with each heartbeat — had dropped by 20%. Heart issues weren’t new to Rhett. He already had a pacemaker due to complications from previous treatment for an abnormally fast heartbeat. And he was aware that traditional pacing, which involved placing a lead in the right ventricle, could eventually cause side effects like his weakened left ventricle.

Rhett's Story

RUSH Stories

Jan 2022 – Dec 2022 National is all hospitals participating in Afib Ablation registry (n=168) Regional is all urban teaching hospitals in Illinois (n=11) Volume: 40 procedures

Follow-up events

Ablations

EP Study

Extractions

ICD Implants

ILR/ICM

Other

Pacemaker Implants

Total Procedures

FY19 Final

FY20 Final

FY21 Final

FY22 Final

FY23 Projected

800 750 700 650 600 550 500 450 400 350 300 250 200 150 100 50 25 0

Ablation (Afib)

1,700 1,600 1,500 1,400 1,300 1,200 1,100 1,000 900 800 700 600 500 400 300 200 100 0

1,353

1,180

1,408

1,614

190

201

166

171

226

340 320 300 280 260 240 220 200 180 160 140 120 100 80 60 40 20 0

252

213

253

295

342

340 320 300 280 260 240 220 200 180 160 140 120 100 80 60 40 20 0

116

172

176

160

340 320 300 280 260 240 220 200 180 160 140 120 100 80 60 40 20 0

274

194

193

221

144

170 160 150 140 130 120 110 100 90 80 70 60 50 40 30 20 10 0

130

170 160 150 140 130 120 110 100 90 80 70 60 50 40 30 20 10 0

210 200 180 160 140 120 110 100 90 80 70 60 50 40 30 20 10 0

182

156

172

159

180

500 470 440 410 380 350 320 290 260 230 200 170 140 110 80 60 30 0

139

162

263

304

424

401

382

510

542

680

Ablation (SVT)

Ablation (AV)

Ablation (VT)

Ablations

Ablation (Afib)

Ablation (SVT)

Ablation (VT)

Ablation (AV)

EP Study

Extractions

ICD Implants

ILR/ICM

Other

Pacemaker Implants

Total Procedures

1,616

FY23 Lab Volumes

The RUSH electrophysiology (EP) team sees patients in seven clinics across Chicago, and while the majority of them come from Chicago and the surrounding communities, patients from 20 other states also come to RUSH to receive care. In 2022, RUSH opened new clinic locations in Lincoln Park and Oakbrook, Illinois, and Northwest Indiana. We also opened a newly renovated EP clinic in the RUSH Professional Building, Suite 358. In spring 2023, RUSH Oak Park will open a new EP lab that will further expand RUSH’s capacity for these types of procedures and become a system-wide arrhythmia center.

RUSH’s Coordinated EP Care Team Model

As one of the only coordinated electrophysiology (EP) care teams in the Midwest, RUSH’s EP care team delivers outstanding patient care and satisfaction, while also playing an integral role in supporting RUSH’s superior results. The care team provides a formal structure to guide patients through their time with RUSH from education to scheduling procedures. The EP team consists of patient navigators, nurses and clinic coordinators who work together with RUSH physicians, advanced practice providers and EP lab staff to ensure that patients are supported through every step of their care. RUSH’s patient navigators specialize in case creation, coordination, patient scheduling and obtaining pre-authorizations. They also are in touch with patients about procedure times and for appointment reminders, providing them with smooth transitions throughout their EP care. The EP nurses at RUSH are responsible for providing patients with education before the procedure and answering their calls afterward. They also communicate test and lab results and provide a medication review at each patient touchpoint. The EP nurses also manage referrals, staff and MyChart messages while providing clinical support. The EP clinic coordinator completes medical record collection for all new patients, checks patients in and then checks on them after and assists with appointment scheduling, reminding patients about them and then calling if they do not arrive as scheduled.

A RUSH cardiology team presented two posters at the American College of Cardiology (ACC) Quality Summit that took place Sept. 14 to 16, 2022, and had over 1,000 attendees. The summit highlighted initiatives to tackle the most common and pressing problems improving the quality of cardiology care. Overall, of the 100 posters submitted for publications from all attendees, only six were selected for presentation. Sonal Patel, PA-C, presented on the safety of same-day discharges for patients undergoing catheter ablation for atrial fibrillation. She showcased how the RUSH electrophysiology (EP) team decreased the length of stay for patients discharging the same day while not increasing complication rates. The work by the EP team earned it second place at the conference. Julie Merz, Cardiology’s clinical quality manager, who represented the heart failure (HF) team, presented on the decrease in HF readmissions after implementing the Readmission Engagement and Care Transitions (REACT) program. The REACT team consists of cardiologists, advanced practice providers, a doctor of Pharmacy, a heart failure nurse care manager and a heart failure social worker who provide wraparound care services for high-risk patients needing more support. The REACT team earned an honorable mention at the conference.

ACC Quality Summit

Patient Satisfaction

4,648

5,297

7,141

7,618

8.000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0

FY20

FY21

FY22

FY19

14%

Outpatient Visits

Increase

35%

Increase

FY20

FY21

FY22

FY19

1,355

1,179

1,462

1,586

1,600 1,400 1,200 1,000 800 600 400 200 0

Procedure Volumes

Increase

24%

Decrease

13%

Programmatic Areas

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RUSH Arrhythmia Center

His-bundle pacing

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Atrial fibrillation clinic

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For FY 2022, Press Ganey presented their outpatient survey data for RUSH’s EP program, which included the following highlights:

National Performance: .9% Regional Performance: 0%

Physicians

Advanced Practice Providers

Parik Sharma, MD Section Chief, Electrophysiology Director, Electrophysiology Lab

in quality.

Nationally Ranked Care

A RUSH cardiology team took part in the Vizient Connections Summit, Sept. 19 to 21. This summit brought together over 4,000 attendees and representatives from over 1,000 hospitals to discuss topics that included health equity, post-pandemic strategy and quality improvements. Tisha Suboc, MD, advanced heart failure cardiologist, and Julie Merz, Cardiology’s clinical quality manager, represented the HF team as part of a panel called “Reducing Readmissions Using AI, Predictive Analytics and Interdisciplinary Teams.” They highlighted the incredible work of the REACT team to decrease heart failure readmissions using the interdisciplinary team in combination with RUSH’s heart failure risk score. Vizient ranked RUSH University Medical Center No. 3 in its 2022 quality and accountability study.

U.S. News & World Report ranked RUSH University Medical Center among the best in the nation for cardiology and heart surgery care.

National Performance: 96.8% Regional Performance: 93%

National Performance: .5% Regional Performance: 2%

National Performance: 11.9% Regional Performance: 11.8%

Procedures by Type

Among the nation's best, again.

Clinicians in the RUSH Arrhythmia Center offer patients with heart arrhythmias the full spectrum of innovative treatments that include medications, ablation and cardiac implantable devices, such as conduction system pacing.

RUSH was one of the early adopters of His-bundle pacing in the United States. As leaders in this space, RUSH providers have published more than 80 studies on His-bundle and left bundle branch pacing and are investigators for some of the latest clinical trials.

Electrophysiologists in the RUSH atrial fibrillation clinic treat patients with newly diagnosed, paroxysmal, persistent and permanent atrial fibrillation and help them modify risk factors and slow down progression of this chronic disease.

Heartlight Endoscopic Ablation System clinical trial

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This study is designed to assess the continued safety and effectiveness of the HeartLight System in patients who are being treated for drug refractory, symptomatic and paroxysmal atrial fibrillation.

of patients were satisfied with their care at RUSH

95%

of patients would recommend the RUSH EP program

97%

Clinical Trials

This PCORI-sponsored study will test the comparative effectiveness of His- and left-bundle pacing to biventricular pacing in relation to patient-centered outcomes, including quality of life and patient activity, heart failure hospitalization and mortality in patients with heart failure with reduced ejection fraction who meet traditional cardiac resynchronization therapy criteria. RUSH will be the electrocardiogram core lab for the study.

Cardiac Resynchronization Therapy clinical trial

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