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Exploring the critical need for increased cardiovascular research in central Virginia issues tied to improving care for Virginia patients

Pauley Heart Center Director Greg Hundley outlines how expanded community-based research and training at VCU Health will improve heart care for the state’s aging population

Man in a white lab coat points to MRI images on a computer. Two women in scrubs are looking at the images. Research conducted at VCU Health Pauley Heart Center is focused on heart conditions, such as cardio-oncology, hypertension, diseases of the aorta, electrophysiology, heart failure and women’s heart health. (MCV Foundation)

By: Liz Torrey

The VCU Health Pauley Heart Center is the top heart hospital in Virginia. Pauley’s mission to improve cardiovascular care and reduce health disparities for all is supported by three pillars — clinical care, education and research — and it is currently seeking to grow its team of renowned research-clinicians, with a focus on recruiting those who specialize in forms of heart disease that frequently affect Virginians.

Pauley Heart Center Director Greg Hundley, M.D., recently shared details on his vision for growing VCU Health’s cardiovascular research workforce – and how expanded research infrastructure in Central Virginia would benefit residents.

The VCU Health Pauley Heart Center is seeking support from Virginia to recruit new cardiovascular research leadership. Why does Pauley need to expand its research team at this time?

A third of all the cardiologists currently working in Virginia are over the age of 65. That’s pretty scary. Add to that the fact that cardiovascular disease is the leading cause of death in Virginia and in the nation. Also, the population of Americans 65 and older — the age group that most frequently experiences heart disease — is projected to nearly double in the next 15 years, from around 40 million to 80 million. All of that is going to combine to put a strain on every hospital system in the country.

We won’t have – we don’t have – enough physicians to take care of the people who need care.

VCU Health is an academic medical center, and what makes an academic medical center unique from other hospitals is that our doctors and surgeons are also researchers and teachers. They’re physicians and scientists, and the care they provide is informed by the most recent innovations and research in their field. What does that mean for the average patient? Well, patients treated at any academic medical center, for any condition or procedure, have a 20% higher rate of survival than patients treated at a nonteaching hospital.

One component of what we’re trying to do is build our faculty to support the training of additional physicians. A facility the size of VCU should be training between eight and 14 cardiologists per year. We’re only training six, and that’s because we don’t have enough teaching faculty to enroll additional cardiovascular medicine fellows.

The second thing we’re trying to do is to recruit experts in particular areas of cardiovascular medicine. Cardiovascular disease is a very broad spectrum. About half of the spectrum is what we call ischemic heart disease, which is when people develop blockages in their arteries. The rest of the spectrum can be divided into a number of smaller pieces, all of which are [heart] disease processes that are complicated and specific. You need experts who not only understand all of cardiovascular health but who are also specifically focused in one of those areas.

What “pieces of the pie” are most in need of additional research, and why?

First, we need researchers who focus on women’s health.

I often think about all the blood vessels in our body as roadways. Let’s say the aorta – the large blood vessel that carries blood out of the heart and distributes it around the body – is Interstate 95. The arteries come off this interstate and go to specific organs, like the liver and the kidneys and different segments of the body – these arteries are like Route 360, for example, or a four-lane road like Broad Street. But where are most of the roads in the state of Virginia? They’re in the neighborhoods, right? All the country roads, the neighborhood streets – these blood vessels are your microcirculation.

For whatever reason, heart disease in men tends to affect more of the four-lane roads of the body, and they cause the symptom complexes that we see advertised on TV: “I’m having chest pain, I’m short of breath” — well, you must be having a heart attack.

In women, on the other hand, there’s a proclivity to have disease processes that affect the smaller blood vessels, and the symptom complexes are different — they can mimic things like having an upset stomach. If you’re not listening and putting into context the symptoms that are occurring and the precipitating factors, you may not diagnose women correctly, and they can suffer horribly.

We also need researchers who focus on hypertension. In some communities around this hospital, three out of four people have high blood pressure. We have a lack of awareness of that, and we need to address that, and we need to conceive of new ways to provide blood pressure medications to the people who need them. We are very interested in establishing a hypertension center here at VCU in collaboration with our Division of Nephrology — there’s a lot of cardio-renal management of blood pressure that we need to investigate.

We need researchers who focus on cardio-oncology, too. Patients who are treated for cancer now develop heart disease as a consequence of treatment. We attack cancer by attempting to cut off its blood supply or by disrupting its metabolism, but many cancer drugs can’t tell the difference between cancer and noncancer tissue. What’s the most metabolically active organ in your body? It’s your heart. So it stands to reason that if we’re trying to attack cancer with different therapies, we end up damaging other areas [of the body]. And how you protect the heart and the vascular system is different depending on the type of cancer therapy being used.

We also need some procedural expertise in the “big highway” — the aorta. There are a lot of disease processes that affect the aorta, and we are also discovering that the aorta in turn governs or influences many of the other systems in the body, because it delivers hormones and nutrients to the rest of the body. Surgical procedures are the main treatment for disorders of the aorta — but there are only 96 thoracic[chest] surgeons in the entire state and cardiac surgery is just one sub-specialty of thoracic surgery. We can only train three cardiothoracic surgeons in our current fellowship program each year. We need to recruit new cardiac surgeons to Virginia to ensure help is there when patients need it most.

Finally, we need researchers who study the disease processes around congenital heart defects, inflammation, hypertrophic cardiomyopathy and specific forms of heart failure.

Why does Virginia specifically need to build out its cardiovascular research workforce? Couldn’t these areas of research theoretically be pursued in any state or city?

VCU Health serves a patient population more diverse than most other academic medical institutions in the nation, and these disease processes occur at a very high frequency in this population. Community-based research plays a critical role in increasing accessibility to care and addressing the “why” of a given problem, which we can only do when we have a genuine connection to the needs of the communities we serve.

Providing greater opportunities for our patients to participate in community-based clinical research will also help reduce some of the bias that currently exists in cardiovascular clinical trial results. And VCU Medical Center in Richmond is a quaternary referral center, which means the most medically complex patients are sent to us from hospitals all over Virginia. We are the state’s flagship hospital for caring for the sickest of the sick.

Recruiting researchers in the above areas who can perform preclinical science to discover solutions, who can test therapeutic interventions in clinical trials, who can facilitate and implement cutting-edge treatments that already exist — all those forms of expertise are needed in Central Virginia. When we have an established research team in a particular area of expertise, what that means is that Virginians then have advanced access to the newest and most promising heart health treatments. The Pauley Heart Center already has an incredible team, but we need to grow it in these areas of focus to best serve our aging patient population. Check out more heart health stories on the VCU Health Pauley Heart Center Blog

Check out more heart health stories on the VCU Health Pauley Heart Center Blog