Advancing heart care for Orange County

Cardiology program at UCI Health has evolved into one of the state’s leading destinations for advanced care

Orange, Calif. — For more than two decades, UCI Health Cardiology Services has methodically built itself into one of the state’s leading destinations for advanced solutions and exceptional management of complex heart conditions. And its evolution continues as Orange County’s only heart program based within an academic health system.

“UCI Health is committed to offering patients the latest expertise, treatments and technology in its heart health program,” said Dr. Pranav M. Patel, chief of the Mary & Steve Wen Cardiovascular Division at the UC Irvine School of Medicine.

“The division’s mission has always been to deliver outstanding cardiovascular care, educate the next generation of leaders in cardiovascular medicine, and lead the way in transformative medical research and innovation in this region.”

Before then, heart care in the health system was more traditional.

“We had cardiology services and procedures, but not the same organized, disease-specific infrastructure that we have today around heart failure and on various cardiology specialties,” says Sanam Shirzadegan, cardiovascular service line director.

Building a heart failure program

In 2006, Dr. Dawn Lombardo was recruited as the medical director of the UCI Health Heart Failure Program to address the growing need for specialized expertise and research into the progressive, long-term condition that accounts for 45% of cardiovascular deaths. Heart failure was already a major clinical and public health concern, but the focus, tools and understanding was not yet as it is today.

Lombardo and Nathalie De Michelis, advanced heart failure porgram manager developed a comprehensive program, standardized clinical workflows, improved quality and prepared the team for disease-specific certification.

They also partnered with hospitalists to build a clinical pathway for inpatients and worked with the emergency department physicians to build a heart failure algorithm. An advanced heart failure rotation was also a critical teaching tool for co-workers, nurses and physicians across service lines, notes Patel.

Strong relationships with physicians in the community has further cemented the Orange as a quaternary/tertiary care facility that can accept heart failure patients who need a higher level of care.

“These foundations allowed us to have a more standardized, evidence-based approach to evaluating, treating and managing patients with acute heart failure,” Patel says.

The heart failure program became the first in Southern California to be certified by The Joint Commission, earning its prestigious Gold Seal of Approval for Quality in 2008. Since then, it also has been repeatedly recognized by the American Heart Association for high-quality care. In 2006, UCI Health — Orange was designated as an Orange County EMS Cardiovascular Receiving Center (CVRC), authorizing it to receive patients via the 911 system during a critical cardiac event, such as a heart attack. Now, UCI Health — Fountain Valley, UCI Health — Lakewood, and UCI Health — Los Alamitos are also STEMI receiving centers.

By 2015, the program had grown to include advanced heart failure evaluation, optimization of guideline-directed medical therapy, multidisciplinary care coordination, patient and caregiver education, discharge planning, outpatient follow-up and strategies to reduce hospital readmissions. And it received another certification from The Joint Commission, this time for Advanced Heart Failure.

Mechanical heart support

Despite comprehensive medical management, some heart-failure patients require ongoing assistance, highlighting a need for the program’s next expansion: a mechanical circulatory support program with advanced surgical therapies.

To expand advanced heart failure therapy and its access to the OC community, cardiac surgeon Dr. Fabio Sagebin was recruited to establish a ventricular assist device (VAD) implantation program for patients with end-stage heart failure.

“This was a major leap forward in our ability to provide advanced care for the most critically ill heart failure patients,” Lombardo recalls. It would provide treatment options for patients awaiting a heart transplant as well as those requiring long-term mechanical circulatory support.

Building the VAD program was no small feat, requiring the coordination of multiple care teams and clinical services. The infrastructure for patient selection, evaluation, implantation, post-operative care, education and long-term device management all needed to be put in place.

The program was credentialed in March 2019 and the team implanted Orange County’s first durable VAD in April 2020. Its recipient received a successful heart transplant at another facility in October 2021.

The program has since expanded to include temporary VAD support and extracorporeal membrane oxygenation (ECMO).

“These therapies broadened the program's ability to support patients experiencing cardiogenic shock, severe ventricular dysfunction and other critical cardiac conditions requiring temporary circulatory support,” Sagebin says.

At-home technology

The heart failure toolbox also now includes remote monitoring technology, Lombardo says.

This includes placing sensors in the pulmonary artery, algorithms incorporated into implanted defibrillators or connected home devices such as scales and blood pressure monitors.

“Each technology monitors different early warning signs, allowing our team to identify changes sooner and intervene earlier, with the goal of improving patient outcomes,” says De Michelis.

Women’s heart care

While building out the heart failure program, Lombardo also recognized that women have different needs when it comes to heart disease.

“It’s the No. 1 killer of women,” Lombardo says. “It kills more women than the five other leading causes of death combined: cancer, chronic obstructive pulmonary disease, Alzheimer’s, diabetes and accidents.”

That’s because heart attacks in women present differently than those in men, often delaying their treatment.

UCI Health Women’s Heart Services, led by Dr. Jin Kim, is the only academic medical center-based program in Orange County dedicated to female-specific heart disease and underdiagnosed conditions.

In addition, cardiologist and maternal-fetal medicine specialist Dr. Afshan B. Hameed, created the only risk-assessment toolkit for obstetric patients and spearheaded a national study showing that it nearly doubled the odds of uncovering a potential for cardiovascular disease (CVD) compared with clinical evaluation alone.

Innovative programs, prevention strategies

UCI Health Cardiology Services occupies a unique position in the region for advancing heart care and knowledge of conditions affecting the heart. Its innovative programs also include:

The structural heart program, spearheaded by Dr. Antonio Frangieh with the assistance of Dr. Jin Kim as the structural heart imaging expert and our skilled cardiac surgeons, provides access to leading-edge treatments like Transcatheter Aortic Valve Replacement (TAVR) and conducts groundbreaking research on tricuspid valve disorders. In 2022, UCI Health — Orange had the first program in Orange County designated as a TAVR Benchmark Center of Excellence by Edwards Lifesciences, serving as a model for TAVR standards.

The echocardiography program, led by Dr. Jin Kim.

The cardiac amyloidosis program, led by Dr. Roxana Ghashghaei, focuses on the diagnosis and treatment of a rare heart muscle disease caused by the buildup of abnormal, misfolded proteins in the heart tissue. The hypertrophic cardiomyopathy service, led by Dr. Behram Mody, is dedicated to the comprehensive care of patients with a genetic heart disease where the heart muscle becomes abnormally thick and stiff.

The cardio-rheumatology program, led by Dr. Amin Sabet, a rapid expanding field focusing on early detection, personalized risk management, and coordinated care for patients with autoimmune disease and heart health concerns.

Specialized services like cardio-oncology, minimally invasive cardiac surgery, advanced cardiac imaging, and Electrophysiology/pacemaker expertise led by Dr. David Donaldson.

At the forefront of integrative cardiology

Integrative cardiology combines evidence-based diagnostic tools and treatments with Eastern medicine and preventive therapies to provide patients with a whole-person approach to their health. Founded by Dr. Shaista Malik and led by Dr. Ailin Barseghian El-Farra, Dr. Irmina Gradus-Pizlo and Dr. Ali Naqvi, this team practices at the Susan Samueli Integrative Health Institute, part of UCI Health, on the UC Irvine campus.

The cardiovascular prevention and lifestyle intervention program connects patients with vital support services, including:

• Dietitians
• Exercise physiologists
• Cardiac rehabilitation specialists
• A heart health coaching program
• Living Well with Heart Failure classes and the Advanced Heart Failure & VAD Support Group

What’s next

Patel says that the long-term vision includes continued development of advanced therapies that strengthen patient outcomes.

“Through these efforts, the program remains committed to providing coordinated, evidence-based, patient-centered care across the full spectrum of heart failure, from early disease management to the most complex forms of mechanical circulatory support,” Patel says.

In addition, the cardiovascular faculty oversees a portfolio of heart health-related clinical trials that are widely regarded as a leading force for advancing cardiovascular medicine and technology in Orange County.

Where to get heart care

UCI Health and the cardiologists of the Mary & Steve Wen Cardiovascular Division in the UC Irvine School of Medicine are committed to providing world-class care at 11 UCI Health locations, including the Tsai Ya Au Heart & Vascular Pavilion at UCI Health — Orange and the Joe C. Wen & Family Center for Advanced Care in Irvine.

Make an appointment by calling 714-456-6699.

Learn more about the 50th Anniversary of UCI Health.