1. science
2. medicine
3. surgery

Changing
practice
Changing
lives
Duke Heart Report 2012
Changing
practice
Changing
lives
obert J. Lefkowitz, MD
R
Winner, 2012 Nobel Prize in Chemistry
g
g
letter from leadership
The Duke Heart Center is consistently recognized as one of the premier cardiovascular
treatment and research centers nationally and internationally. Our goal is simple—to
provide state-of-the-art, evidenced-based patient care while continually advancing the
practice of cardiovascular medicine through our robust clinical research programs.
Our commitment to caring for patients with heart disease
begins with impactful research—from the seminal work
conducted by Robert J. Lefkowitz, MD, for which he was
recently awarded the 2012 Nobel Prize in chemistry, to
our leadership and participation in virtually every major
heart-related investigational network, clinical trial, and
registry—including the 40-year-old Duke Databank for
Cardiovascular Research, which in the 1990’s led to the
creation of the Duke Clinical Research Institute and
continues to be a rich source of research data today.
Perhaps most importantly, we continue to translate the
discoveries and findings from our research into innovative
models of care that draw together multidisciplinary teams
of specialists and staff in new ways to, among other things,
ensure that the most appropriate, effective therapies are
selected and delivered to all of our patients. (See pages 8-9.)
Our faculty also continue to have a profound impact on
setting standards for quality heart care through their work
with the American Heart Association, American College of
Cardiology, National Heart, Lung, and Blood Institute, and
many others. Through our growing network of affiliated
heart centers, we are working to help advance the delivery
of the highest quality of care throughout the Southeast.
Through these efforts we are changing practice—and
changing lives. We’re pleased to share with you our latest
initiatives, innovations, and achievements in this year’s
Duke Heart Report.
Christopher M. O’Connor, MD
Victor J. Dzau, MD
Director, Duke Heart Center
Chief, Division of Cardiology
Professor of Medicine
Chancellor for Health Affairs, Duke University
President and CEO, Duke University Health System
James B. Duke Professor of Medicine
Director, Molecular and Genomic Vascular Biology
facts and stats
Ranked among the top 10 programs nationally,
Duke Heart Center serves more than 65,000 patients every year
Patient Volumes
Duke University Health System, CY11
Procedure Volumes
Duke University Health System, CY11
182,877
Total Patient Visits
175,182
Outpatient Visits
Inpatient Discharges
7,402
Unique Patients
Figures are for calendar year 2011. Volumes are for Duke University Hospital,
Duke Raleigh Hospital, Durham Regional Hospital, and hospital-based locations.
14,888
Cardiac Catheterizations**
Arrhythmia/EP
68,281
26,644
Adult Echo*
Peripheral Vascular***
2,800
1,614
*Includes stress echo and TEE **Diagnostic and interventional
***Noninvasive arterial and carotid, plus diagnostic and interventional
peripheral and carotid
The People of Duke Heart Center
1200+
Total Faculty and Staff
Board-Certified Cardiologists, Cardiac Surgeons,
and Cardiothoracic Anesthesiologists
110+
Cardiac and Cardiothoracic Surgical Nurses
One of the Nation’s Top Cardiovascular Critical Care Units
Duke University Hospital’s 16-bed Cardiac Care Unit (CCU) is one of the nation’s top
acute myocardial infarction care units, serving some 1,700 critically ill patients each year.
Duke Heart Center
888-HRT-DUKE
800+
Exceeding Benchmarks
Leader in Minimally
Invasive Surgery
With more than 900 open-heart procedures annually,
Duke’s volumes far exceed those suggested by national
guidelines—and survival rates consistently exceed Society
of Thoracic Surgeons benchmarks.
More than half of the general thoracic
surgeries performed at Duke annually use
minimally invasive techniques—compared
to 20 to 30 percent nationally.
Heart Surgery Volumes and Mortality
Duke University Medical Center
GENERAL THORACIC SURGERY VOLUMES
1.90%
2008
3.32%
2009
1.62%
2010
2.58%
1,018
2011
1.72%
990
910
935
1,048
44
Other
2007
748
2008
748
2009
787
2010
2011
Min. Invasive
CARDIOVASCULAR AND THORACIC SURGERY VOLUMES
Duke University Medical Center, CY11
73
1,429
Isolated CABGs
3,673
TEE
485
1,388
888
1,486
1,018
1,654
Total Procedures
Volumes for Duke University Hospital, Durham
Regional Hospital, and Duke Raleigh Hospital, CY11
Duke performed 147 lung transplants in
2011 with survival rates that far surpass
the national average.
Isolated Valves
109
CABG and Valves
ONE-YEAR LUNG TRANSPLANT
PATIENT SURVIVAL RATE
89.04%
81.76%
duke
US
50
Thoracic
Echo
2,769
1,302
#1 Volume in the U.S.
372
342
1,654
20,202
Vascular
3,155
Cardiac MRI
Volumes
Adult Congenital
IMAGING PROCEDURE
VOLUMES, CY11
Stress Echo
2007
Mortality Rate
Among the world’s
highest volumes
Heart Transplant
147
Lung Transplant
From the Scientific Registry of Transplant Recipients
(srtr.org), for adults receiving their first transplant
between 1/1/09 and 6/30/11. A p-value of 0.01
indicates that this difference is statistically significant.
2,059
Nuclear imaging tests
Stress echo and nuclear imaging
volumes for Duke University Hospital,
Duke Clinic, and Duke Health Centers
at Southpoint and North Duke Street.
MRI volumes for Duke University
Hospital and Duke Clinic.
Among the Southeast’s
Highest-Volume
Interventional Cath Labs
12,038
Diagnostic
(coronary and peripheral)
3,073
Interventional
(coronary and peripheral)
Cardiac catheterization lab procedure
volumes for Duke University Health
System and affiliate sites, CY11
2012 Report
3
Defining Best Practices
“When the American Heart Association announced its top advances in cardiovascular quality of care and
outcomes research for 2011, more than half of them involved Duke faculty. That speaks volumes.”
–
Eric D. Peterson, MD, MPH
Director, Duke Clinical Research Institute
Duke Heart Center is internationally known for translating scientific discoveries
into better treatments for heart disease—and expanding the evidence base for
clinical practice worldwide.
 Duke
is a founding site of both the



Duke Heart Center
888-HRT-DUKE
DCRI faculty published 568 papers in peer-
NIH-funded Heart Failure Clinical
reviewed journals during the 2011-2012
Research Network and the Clinical
academic year—more than 20 percent of
and Translational Science Awards
them in high-impact journals
Consortium



Duke Heart Center faculty receive more
One of nine US sites in the NIH-funded
than $130 million in cardiovascular
Cardiothoracic Surgical Trials Network
research funding each year from govern-
Research coordinating unit for the NHLBI
ment and private sources, including more
Centers for Cardiovascular Outcomes
than $5 million for basic research and more
Research
than $110 million for clinical research
Home to the Duke Databank for Cardio-

60 cardiology studies and 18 cardiotho-
vascular Disease—the world’s largest and
racic surgery studies are currently under
oldest such outcomes registry, with infor-
way at Duke Heart Center—including a
mation on more than 200,000 patients
number of “first-in-man” studies.
Home to Duke Clinical Research Institute

Home to the editors of The Journal of Clinical
(DCRI)—the world’s foremost academic
Investigation, the American Heart Journal,
research organization—which has conduct-
and the Journal of the American College of
ed more than 870 studies in 65 countries
Cardiology: Heart Failure, premier venues for
at more than 37,000 sites, enrolling more
disseminating critical advances in cardiovascu-
than 1.2 million patients
lar research
National Leadership
Setting National Quality
and Appropriateness Guidelines
Duke leads the creation of national quality
standards through work with entities such as
the Centers for Medicare and Medicaid Services, the Food and Drug Administration, and
the National Academy of Sciences’ Institute
of Medicine.
Faculty are also leading and serving on
committees of the American College of
Cardiology (ACC) and the American Heart
Association (AHA) to develop appropriateness guidelines and performance indicators
for cardiovascular imaging, PCI, CABG,
ICDs, TAVR, and more—as well as chairing
the overarching ACC/AHA Performance
Measures Task Force that champions the
development of new performance measures
to improve cardiovascular care quality.
Home to National Registries
Duke is the coordinating center and analytic
engine for national quality initiatives that
collect data from US hospitals to improve
treatment and outcomes:
 Society of Thoracic Surgeons (STS)
National Database
 AHA’s Get With the Guidelines initiative
 AHA, American Diabetes Association,
and American Cancer Society’s The
Guideline Advantage outpatient registry
 ACC’s National Cardiovascular Data
Registry percutaneous coronary intervention registry and the NCDR-ACTION
acute coronary syndromes registry—each
the world’s largest clinical registry in its class
 ORBIT-AF, the nation’s largest longitudinal registry of atrial fibrillation patients
 PREVAIL, a large registry of diabetic
treatment in clinic populations
 STS/ACC TVT Registry, the post-market-approval registry for transcatheter
aortic valve replacement (TAVR)
Robert M. Califf, MD
Robert Jaquiss, MD
Eric Peterson, MD, MPH
Member, American Heart Association,
Scientific Publishing Committee
Member, NIH National Advisory Council on Aging
Member, IOM Board on Health Sciences Policy
Member, NHLBI Board of External Experts
Member, Board of Directors, Society for
Clinical and Translational Sciences
Member, CTSA External Advisory Board
Editorial Boards: American Heart Journal,
Circulation, European Heart Journal,
Journal of the Society of Clinical Trials
Chairman, Berlin Heart Study Group and
Publications Committee
Member, Education Committee of the American
Association for Thoracic Surgery
Member, Membership Committee for the
Congenital Heart Surgeons’ Society
Robert J. Lefkowitz, MD
Chair, ACC/AHA Performance Measures Task Force
Board President, AHA Mid-Atlantic Affiliate
Member, AHA Strategic Executive Planning Committee
Member, ACC Quality Oversight Committee
Member, FDA/CDRH MDEpiNET Technical
Working Group
Member, Institute of Medicine (IOM) Large,
Simple Trials Group
Member, ACC/AHA Guidelines on the
Management of Unstable Angina/Non-ST Segment Elevation Myocardial Infarction
Member, AHA Guidelines for Secondary Prevention
Contributing Editor, JAMA
2012 Nobel Prize in Chemistry (shared)
Howard Rockman, MD
Jennifer Li, MD
Editor in Chief, The Journal of Clinical
Investigation, 2012-2017
James Daubert, MD
Simon Dack Award for Outstanding
Scholarship, Journal of American College
of Cardiology, 2011
Senior Consulting Editor, Journal of American College of Cardiology, 2012
Pamela S. Douglas, MD
Member, NHLBI External Advisory Council
Member, National Space Biomedical Research Institute External Advisory Council
Co-Chair, FDA Standardized Data Collection
for Cardiovascular Imaging Initiative
Chair, ACC Publications Committee
Co-Chair, ACC Cardiovascular Leadership Institute
Chair, ACC Quality in Technology Working Group
Chair, ASE Extramural Research Committee
Donald Glower, MD
Member, The Journal of Thoracic and
Cardiovascular Surgery Editorial Board
Member, Journal of Cardiac Surgery Editorial Board
Member, South Atlantic Cardiovascular Society Steering Committee
Co-Principal Investigator, EVEREST Evalve
FDA Phase III Trial
Christopher Granger, MD
Chair Emeritus, AHA Mission: Lifeline Member, ACTION Registry: GWTG Research and
Publications Committee
Member, NHLBI Board of External Experts
G. Chad Hughes, MD
Member, The Society of Thoracic Surgeons
Task Force on Thoracic Endografting
Member, The Society of Thoracic Surgeons/
FDA Center for Devices and Radiological
Health (CDRH) Network of Experts
Percutaneous Heart Valves Bench
William E. Kraus, MD
Member, Board of Trustees, American College
of Sports Medicine
Member, Board of Directors, International Society
for Physical Activity and Health
Member, Institute of Medicine committee to evaluate Pediatric Drugs and Biologics under the Best Pharmaceuticals for Children Act
Joseph P. Mathew, MD, MHSc
Chair, Neurocognitive Committee, Cardiothoracic
Surgical Trials Network
Member, Abstract Review Committee,
Society of Cardiovascular Anesthesiologists
Member, Database Task Force, Society of
Cardiovascular Anesthesiologists
L. Kristin Newby, MD, MHS
Chair, Council on Clinical Cardiology,
American Heart Association
President, Society of Cardiovascular Patient Care
Senior Associate Editor, Journal of the
American Heart Association
Member, ESC/ACC/AHA/WHF Task Force for
the Redefinition of Myocardial Infarction
Christopher O’Connor, MD
Editor-in-Chief, Journal of the American College
of Cardiology: Heart Failure
Treasurer, Heart Failure Society of America
FDA Working Group: Acute Heart Failure
Syndromes—Clinical Trials
NIH/NHLBI Working Group: Emergency
Department Management of Heart Failure
NIH/NHLBI Working Group: Cardiac Transplantation
Workshop and Guidelines Committee
Magnus Ohman, MD
Member, FDA Center for Device Evaluation Panel
Member, ACC/AHA Guidelines Oversight Committee
Member, ESC Task Force for Non-STEMI Guidelines
Joseph Rogers, MD
Board of Directors, International Society
for Heart and Lung Transplantation
Vice Chair, UNOS Thoracic Committee
Principal Investigator, HeartWare ENDURANCE Trial
Peter K. Smith, MD
Vice Chair, ACC/AHA CABG Guidelines Committee
Member, Advisory Panel, Joint Commission/AMA
National Overuse Summit for PCI
Member, Writing Committee, ACCF/SCAI/STS/
AATS/ASNC Appropriateness Criteria
for Coronary Revascularization
Member, Relative Value Update Committee, AMA
Member, ACCF/AHA/PCPI CAD/HTN Committee;
PCPI Quality Measures Committee, AMA
Top Doctors
Six Duke Heart Center cardiologists and three
cardiothoracic surgeons were recognized as Top
Doctors by U.S.News & World Report—estimated
to be among the top one percent in their specialty
nationwide.
Cardiologists
Thomas M. Bashore, MD; Robert M. Califf, MD;
J. Kevin Harrison, MD; Christopher M.
O’Connor, MD; Harry R. Phillips III, MD;
Joseph G. Rogers, MD
Cardiothoracic surgeons
Thomas A. D’Amico, MD; David H. Harpole Jr., MD;
Peter K. Smith, MD
Manesh Patel, MD
Chair, AHA Diagnostic and Invasive Cath Committee
Chair, Writing Committee, ACCF/SCAI/STS/AA
TS/ASNC Appropriateness Criteria for Coronary
Revascularization
Member, ACC Task Force, Appropriate Use Criteria
Writing Committee, AHA/ACC CABG
Guidelines Committee
2012 Report
5
Leading the way with TAVR
Research That Changes Practice
tavR volumes*
76
11
sapien
corevalve
Four decades with Duke—and counting
Bobby Hartley’s relationship with Duke started forty
years ago, when at the age of seven he was diagnosed with
Hodgkin’s lymphoma. Chemotherapy and radiation to his
chest cured the lymphoma, but weakened his heart. Last
year, Bobby was diagnosed with congestive heart failure.
He needed an aortic valve replacement, but was not a
candidate for open surgery because of a severely calcified,
“porcelain” ascending aorta. Duke’s leadership in advancing transcatheter aortic valve replacement (TAVR) gave
Bobby access to more options. In May 2012, he underwent
a TAVR procedure and less than a day later was up and
walking around. “My heart failure made me feel like I was
drowning,” he said. “After my procedure, I started feeling
better almost immediately. It was truly an amazing thing.”
Duke Heart Center has helped pioneer the use of transcatheter aortic valve implants, which offer a lifesaving option
for patients who are not able to undergo open surgery.
Our experience and outcomes with both the CoreValve and
Sapien Valve systems, mean we are able to offer this minimally invasive option to a much wider spectrum of patients.
Learn more on page 19.
*Data as-of 11/6/12
Changing Practice Through Clinical Research
Internationally renowned for cardiovascular clinical research, Duke Heart Center and Duke Clinical
Research Institute conducts pivotal studies that define best clinical practices. A few examples:
STICH—The largest-ever trial of surgical therapy in ischemic heart failure, STICH compared coronary artery bypass grafting (CABG) surgery plus medical management
to drug therapy alone. Researchers found no difference in
overall survival but lower rates of cardiovascular events
for patients with CABG.
N Engl J Med. 2011; 364(17):1607-1616.
ARISTOTLE—This study of 18,201 patients with atrial
fibrillation found apixaban superior to warfarin in preventing stroke. A 2012 Duke study published in Lancet
showed apixiban’s superiority held true regardless of the
risk score used and regardless of the patient risk category.
N Engl J Med 2011; 365:981-992
ROCKET-AF—This DCRI-led international study of more
than 14,000 patients found rivaroxaban equally effective
as warfarin in preventing stroke in AFib patients—while
providing more consistent and predictable anticoagulation effects. Rivaroxaban was approved by the FDA for
use in atrial fibrillation patients based on the ROCKETAF results. N Engl J Med 2011; 365:883-891
ASCEND-HF—Duke researchers led the largest-ever trial
to evaluate the effectiveness of nesiritide as a treatment
for dyspnea in patients with decompensated heart failure,
determining that the drug was no better than placebo yet
increased rates of hypotension.
N Engl J Med. 2011 Aug 25; 365(8):773.
Appropriate use of ICDs—A Duke-led retrospective
study using data from the National Cardiovascular Data
Registry (NCDR)’s ICD Registry found that 22.5 percent
of patients receiving implantable cardioverter-defibrillators (ICDs) did not meet evidence-based criteria for
implantation. JAMA. 2011; 305(1):43-49.
Appropriate use of PCI—A Duke review of data from
the NCDR CathPCI Registry found that while almost
99 percent of percutaneous coronary interventions (PCI)
performed in acute settings followed standard criteria for
appropriate use, only half of PCIs performed in non-acute
settings were appropriate—suggesting “an important
opportunity to examine and improve the selection of
patients undergoing PCI in the non-acute setting.”
JAMA. 2011; 306(1):53-61.
CABANA—Duke is the #1 U.S. enroller—#2 worldwide
—in the largest-ever and most significant clinical trial of
its kind comparing catheter ablation to anti-arrhythmic
drug therapy in atrial fibrillation patients. Coordinated by
Duke Clinical Research Institute, the 140-site trial will determine which therapy is best in terms of reducing mortality,
reducing treatment costs, and preserving quality of life.
BRIDGE—This NHLBI-funded trial led by DCRI is
designed to establish an evidence-based standard of care
for patients who must temporarily stop using warfarin
because of elective procedures or surgery.
ISCHEMIA—DCRI serves as the statistical and data
coordinating center as well as the economics and qualityof-life coordinating center for this international study to
determine whether invasive procedures combined with
medical therapy improve outcomes compared to medical
therapy alone in the initial treatment of ischemic heart
disease.
TECOS and EXSCEL—Multinational trials coordinated by
DCRI and the University of Oxford (UK) Diabetes Trial
Unit to evaluate the cardiovascular outcomes of adding
sitagliptin (TECOS) or exenatide (EXSCEL) to the usual
care of patients with type 2 diabetes. TECOS completed
enrollment of over 14,000 patients in June 2012, with
results expected in 2015; EXSCEL is enrolling 9,500
patients with results expected in 2017.
PROMISE—This 150-site study is the first to compare
how two kinds of diagnostic tests—anatomic testing with
CT angiography versus functional testing with stress imaging or exercise ECG—correlate to outcomes in patients
presenting with chest pain. Results are expected to have a
major impact on health-care policy and practices.
2012 Report
7
Redesigning Care
Half the battle in advancing heart care
is working evidence-based procedures
into practice. Duke Heart Center has
designed revolutionary models of care
that do exactly that.
EMS use of pre-hospital
12-lead ECG
88%
67%
Pre RACE-ER
Post RACE-ER
They call him “Miracle Man”
Andy Smith lives deep in the North Carolina mountains,
nearly two hours by winding roads from the nearest cath
lab. It was not a good place to be when he suffered a
heart attack with left-bundle branch blockage. Smith was
ambulanced and airlifted to a hospital at a breathtaking
rate, all thanks to the Duke-designed Regional Approach
to Cardiovascular Emergencies (RACE) system that re-
vamped protocols for hospitals and EMS teams to speed
up heart-attack treatment statewide. Along the way, his
heart stopped seven times and went into fibrillation at
least 39 more, but the specially trained team kept him
alive until he could receive lifesaving percutaneous coronary intervention (PCI)—only 72 minutes after he was
picked up from his home.
The RACE-ER project is a collaborative network of PCI
centers, EMS providers and other care teams throughout
NC working to improve STEMI care. EMS teams are able
to interpret ECG readings faster and prepare care teams
at destination PCI hospitals, greatly decreasing the time
between heart attack and the provision of life-saving
care for the patient.
New Evidence-Based Models of Care
Duke Heart Center has pioneered nationally recognized approaches
to delivering heart care more efficiently and effectively, including:
RACE: Regional Approach
to Cardiovascular Emergencies
Introduced in 2003 by Duke Heart Center and named a
2007 American Heart Association (AHA) top 10 research
advance, RACE has improved myocardial infarction (MI)
care in North Carolina by creating a statewide system
of rapid coronary artery reperfusion delivery to patients
with ST-elevation MI (STEMI). Now involving 119
hospitals and 540 regional EMS agencies in all 100 North
Carolina counties, phase two—called Reperfusion of Acute
MI in Carolina Emergency Departments - Emergency
Response (RACE-ER)—has improved treatment times
between first medical contact (by EMS) to balloon or
device time throughout the state. North Carolina care teams
meet the 90-minute STEMI threshold 75 percent of the time,
compared to 68 percent of PCI centers nationally.
An expansion of the RACE program, called Regional
Approach to Cardiovascular Emergencies Cardiac Arrest
Resuscitation System (RACE CARS), was made possible thanks to funding from the Medtronic Foundation’s
HeartRescue Program. RACE CARS aims to improve
survival of out-of-hospital sudden cardiac arrests by 50
percent over five years. Currently, 92 percent of North
Carolinians who suffer sudden cardiac arrest (SCA) each
year die. Strategies to improve survival include: teaching
quality bystander CPR and the use of automatic defibrillators; ensuring rapid defibrillation and transport of
patients to the most-appropriate hospital; and increasing
the use of evidence-based interventions, such as primary
PCI for STEMI and therapeutic hypothermia for comatose patients.
Duke is in the process of evaluating expansion of the
RACE network and protocols to include aortic dissection
and cardiogenic shock.
Resources for Advanced Heart Failure
Duke offers an innovative Heart Failure Disease Management Program that has shown to reduce inpatient
admissions, length of stay, and costs. In Fall 2012, Duke
opened a multidisciplinary walk-in HF clinic that can
offer infusion and ultrafiltration services for advanced
HF patients. This novel offering is available nowhere else
locally and is available only a few other places nationally.
The level of service and convenience is akin to an urgent
care model, but exclusively for HF treatment. (see page 15)
The clinic is part of the new Center for Advanced Heart
and Lung Disease.
Hypertension Management Initiatives
Established in early 2012, our Resistant Hypertension
Program involves a team of cardiologists, nephrologists,
a physician assistant and research coordinators to assist
in the management of patients with resistant hypertension. Treatment strategies are based upon a patient’s
prior treatment history, underlying cause of hypertension,
barriers to treatment and target organ damage. The team
provides assistance with blood pressure management
and opportunities to participate in clinical research trials
including the Symplicity HTN-3 study (see page 13).
Duke is participating in an AHA-funded initiative
called Secondary Prevention Risk Interventions via
Telemedicine and Tailored Patient Education (SPRITE),
a home-based telemedicine study that is a randomized
trial of tailored and telemedicine-based interventions for
risk-factor modification in patients after MI. Participants
receive home BP-monitoring equipment that automatically uploads their BP to the AHA portal. Patients receive
either Web-based education or nurse-delivered education
by phone to assist in BP reduction and control.
Team Approach to Clinical Care and Access
Duke Heart Center employs team-based care on both
inpatient and outpatient fronts to enhance the effectiveness and timeliness of treatment. Highlights include:
teams of cardiologists, pulmonologists, and specially
trained advanced practice providers and other team
members across related sub-specialties who provide
collaborative clinic coverage.
 Multidisciplinary evaluations by cardiologists and car-
diothoracic surgeons to determine objectively the best
treatment for each patient, backed by joint research to
compare the effectiveness of medical, cardiology interventional, surgical, and hybrid treatments on a population level. This represents the “Heart Team” approach
that is newly called for in the Coronary Revascularization National Guidelines and Appropriate Use Criteria
sponsored by the American Heart Association and the
American College of Cardiology.
Innovative Lung Transplant Protocols
In 2011, Duke’s median wait time for lung transplant
was only 12 days, thanks to aggressive organ-recovery
strategies. We have seen excellent outcomes in transplanting patients who have not historically been candidates for
lung transplantation, including those older than 70; patients with cystic fibrosis whose lungs are colonized with
resistant pathogens; patients with concomitant coronary
artery and/or valvular heart disease; and patients with
respiratory failure requiring mechanical ventilation and
extracorporeal membrane oxygenation (ECMO).
The Duke Lung Transplant Program, the nation’s
largest program of its kind, was established in 1992. Since
then, the Duke team has performed more than 1,100 lung
transplants—145 in 2011 alone. Our program is proud to
achieve both one- and three-year posttransplant survival
that is significantly greater than national averages. Duke
is one of only three US lung transplant sites with better
than expected one-year patient survival.
 Redesigned clinic space to improve patient access and to
maximize efficient care of complex disease by creating
2012 Report
9
locations
Improving Cardiovascular Care Quality
Across the Southeast (and Beyond)
With a robust network of locations and affiliated hospitals,
Duke Heart Center is improving cardiovascular care quality and
outcomes for patients across the Southeastern United States.
Duke University Health System Hospitals
Medical Center Staffed by Duke Heart
Center Physicians
Duke Lifepoint (DLP) Hospitals
Duke Heart Center-Affiliated Hospitals
Adult Cardiology and Cardiothoracic
Surgery Community-Based Practices
Pediatric Cardiology
Community-Based Practices
Life Flight Satellite Locations
Duke Mobile Cardiac
Catheterization Sites
DLP Cardiac Partners Mobile
Cardiac Catheterization Sites
Global Reach
Outside of our home region, Duke Heart Center works to improve
heart care globally through strong clinical and research collaborations
with partners in countries including:
Singapore
Duke-National University of Singapore Graduate Medical School,
National University Health System,
SingHealth
Kenya
ASANTA Cardopulmonary
Center of Excellence
China
Center of Excellence in
Cardiovascular Disease, Beijing
Multinational
Virtual Coordinating Center for
Global Collaborative Cardiovascular
Research (DCRI)
India
Medanta Duke Research Institute
Duke Heart Center
888-HRT-DUKE
Brazil
Brazilian Clinical Research Institute
AFFILIATE CASE STUDIES
Duke Heart Network
Southeastern Heart Center, Lumberton, SC
Quality Care Close to Home
Quality Improvement a Hallmark
The Duke Heart Network works with heart programs
throughout the Southeast to advance the quality and level
of cardiovascular care available to residents in their home
communities. In addition to operating more than 20 mobile cath lab sites and outpatient clinics staffed by Duke
physicians, the Network provides intensive clinical and
programmatic guidance to seven hospital-based cardiac
affiliates:
Alamance Regional Medical Center, Burlington, NC
Each of Duke’s cardiac affiliates undergoes rigorous
quality oversight and process improvement initiatives,
with the goal of exceeding the benchmark measures
of national cardiac registries such as the National Cardiovascular Data Registry and the Society of Thoracic
Surgeons National Database. Some recent highlights:
Beaufort Memorial Hospital, Beaufort, SC
Danville Regional Medical Center, Danville, VA
Indian River Medical Center, Vero Beach, FL
011 ACC-NCDR-Get with the Guidelines
2
Program Performance Achievement Recognition:
Acute Myocardial Infarction
Gold: Danville Regional Medical Center, Danville, VA
High Point Regional Health System, High Point, NC
012 AHA-Get with the Guidelines Program
2
Performance Achievement Recognition: Heart Failure
Lexington Medical Center, West Columbia, SC
Gold: Beaufort Memorial Hospital, Beaufort SC
Southeastern Regional Medical Center, Lumberton, NC
Silver: Danville Regional Medical Center, Danville, VA
012 AHA Mission: Lifeline Program Performance
2
Achievement Recognition-Receiving Hospital
Gold: High Point Regional Health System, High Point, NC
011-2012 HealthGrades Cardiac Care Excellence Award
2
Ranked among the top 10 percent in the nation
for overall cardiac services
arry R. Phillips III, MD
H
Chief Medical Officer, Duke Heart Network
Since Southeastern Regional Medical Center—located in
rural Robeson County, NC—became a Duke Medicine affiliate, mortality rates from heart disease in the region have
decreased far faster than in the rest of the state. Between
2005-2011, mortality rates dropped 12 percent for all North
Carolina residents, but 20 percent for residents of Robeson
County. Source: North Carolina State Center for Health Statistics
Heart Disease—Mortality Rates for NC Residents
Death Rate (per 100,000)
Through collaboration with its affiliate sites,
Duke helps community hospitals achieve clinical excellence.
240
Duke heart affiliation initiated April 2006
230
220
210
200
190
180
2005
2006
Robeson
2007
2008
2009
2010
North Carolina
Danville Regional Medical Center, Danville, VA
Mortality rates for heart attack and heart failure have dramatically declined at Danville Regional Medical Center since
the Virginia hospital became a Duke heart affiliate in 2008.
Source: Centers for Medicare and Medicaid Services Outcome Measures
CMS Annual 30-Day Mortality: AMI
23.3%
16.6%
19.8%
16.2%
18.1%
15.9%
17.4%
15.5%
Southeastern Regional Medical Center, Lumberton, NC
FY05-FY08
CARDIOVASCULAR PROCEDURES AT
DUKE HEART CENTER AFFILIATED SITES
2007
2008
2009
2010
2011
FY06-FY09
FY07-FY10
FY08-FY11
CMS Annual 30-Day Mortality: HF
16.7%
11.1%
4,150
14.6%
11.2%
13.6%
11.3%
12.7%
11.6%
4,790
5,550
FY05-FY08
6,629
DRMC
FY06-FY09
FY07-FY10
FY08-FY11
National Average
8,458
2012 Report
11
Advanced Coronary & Vascular Disease
Programs of distinction
Case Study
James Whitaker has battled heart disease for more than two
sive coronary artery bypass followed by percutaneous stenting
decades. In 1990, at 42, he underwent his first bypass sur-
of the remaining diseased arteries.
gery at Duke. In September 2011, his feelings of fatigue and
breathlessness returned.
nurses’ expectations for recovery in the hospital. “My quality
When Whitaker met with Duke cardiologist E. Magnus Ohman,
of life went from 20 to 100 percent,” he said. “I have a lot of
MD, he was experiencing chest pain. A cardiac catheterization
life left to live.”
revealed extensive coronary damage and the need for a more
aggressive intervention. Ohman, working with Duke heart
surgeon Carmelo Milano, MD, evaluated Whitaker for a hybrid
revascularization, an approach that involves a minimally inva-
eter K. Smith, MD
P
Chief, Cardiovascular and Thoracic Surgery
Duke Heart Center
Whitaker’s procedures went well, and he exceeded even the
888-HRT-DUKE
. Chad Hughes, MD
G
Director, Thoracic Aortic Surgery
Duke cardiologists and cardiothoracic surgeons collaborate
to perform about 20 hybrid revascularizations each year, an
approach available only at major academic medical centers.
anesh R. Patel, MD
M
Medical Director, Percutaneous Interventions (PCI)
. Magnus Ohman, MD
E
Medical Director, Advanced Coronary Disease
Hybrid Operating Room
Symplicity HTN-3
Duke’s hybrid OR—the first in North Carolina—enables cardiologists and cardiothoracic surgeons to perform percutaneous and
open procedures simultaneously. This collaboration reduces the
risk of complications and length of stay associated with multiple
procedures, allowing patients to experience a quicker recovery. Our
hybrid OR is equipped with the most advanced imaging technology,
providing Duke physicians with precise information and improving
overall patient outcomes.
Duke is one of the top enrolling centers in the Southeast for the
Symplicity HTN-3 trial, exploring novel ways to treat patients
with resistant hypertension. The trial is evaluating the effectiveness
of renal denervation for patients whose systolic blood pressure is
greater than 160 in spite of taking three or more blood pressure
medications. Traditionally, these difficult-to-treat patients have
endured multiple drug therapy combinations without success, but
early results from this one-time procedure show a median decrease
in systolic blood pressure of 24 mmHg at six months.
Hybrid Coronary Revascularization
In 2012, Duke completed enrollment in an NHLBI-funded observational study of hybrid revascularization (see case study on facing
page). Results from the study are informing the development of a
pivotal comparative effectiveness study of this transformational
approach to treating patients with complex coronary artery disease,
which combines minimally invasive off-pump arterial grafting of the
left anterior descending artery and simultaneous stenting of other
coronary lesions.
STICH
A 2012 report released by NHLBI named the STICH trial, developed and led by Duke faculty, as one of the most important scientific advances of 2011. The results of this multinational trial showed
no difference in overall survival rates for patients with coronary
disease and heart failure who received CABG compared to optimal
medical therapy, but they did reveal lower rates of cardiovascular
events for CABG patients. The trial follow-up was extended to 10
years through new NIH funding. Both the American College of Cardiology and the European Society of Cardiology have modified their
guidelines to include the STICH results.
NEJM 2011; 364 (17):1607-1616
PRIMARY ISOLATED CABG
VOLUMES AND MORTALITY
2007
1.71%
410
2008
3.13%
405
2009
1.46%
2010
2.03%
2011
2.61%
478
393
345
Mortality Rate
Thoracic Aortic Surgery
As a leading research center for thoracic aortic surgery, Duke participates in virtually all major thoracic endovascular stent graft-related
clinical trials as well as research to determine appropriate patient
selection for endovascular repair of aortic disease. Our faculty are
leading the way in defining the surgical management of Loeys-Dietz
syndrome, a rare connective tissue disorder that increases the risk
of aortic aneurysm. Duke is one of the few centers in the country
that offers “hybrid” repairs for thoracoabdominal and aortic arch
aneurysms. This technique is a combination of open debranching
and endovascular aneurysm exclusion, which eliminates the need for
cardiopulmonary bypass and aortic cross clamp.
Advanced Coronary Artery Disease
One of only a handful of its kind, this program serves patients with
debilitating chest discomfort for which few novel therapies exist
and focuses largely on older people for whom treatments may be
limited. We employ sophisticated angina therapies, such as enhanced
external counterpulsation, a noninvasive treatment that increases
the flow of oxygenized blood to the heart, and spinal-cord stimulation, a pain-blocking therapy used in some chronic and severe cases.
Some 85 percent of patients improve to the extent that they are able
to return to performing most daily activities.
Volumes
Data are for Duke University Medical
Center. Duke’s annual CABG volumes,
which consistently exceed those recommended by the AHA and ACC as
indicators of care quality. And Duke
Heart Center’s cardiac surgeons have
produced consistently exceptional patient
outcomes—with survival rates significantly
higher than what is expected in a patient
population as complex as ours.
THORACIC AORTIC
SURGERY VOLUMES
Duke University Hospital, FY11
96
Ascending Aorta/Root
107
Arch (Open and Hybrid)
47
Descending (Open and endovascular)
43
TAAA (Open and hybrid)
2012 Report
13
Advanced Heart Failure
Programs of distinction
Case Study
When Lynn Gullick, a 59-year-old attorney and mother,
and heart failure specialists worked successfully to manage
couldn’t shake a persistent cough, she went to her doctor,
her heart failure for more than three years. After three hos-
expecting a prescription. Instead, she was diagnosed with
pitalizations in as many weeks, Gullick agreed to be listed for
congestive heart failure.
transplant. Seven days later, Carmelo Milano, MD, a Duke
Referred by Cleveland Clinic to Christopher O’Connor, MD,
heart surgeon, gave Gullick a new heart.
a Duke heart failure specialist, Gullick began medical therapy.
Duke’s multidisciplinary approach meant Gullick was given in-
When imaging showed her condition was worsening, she
dividualized treatment options for her failing heart. And Duke’s
was evaluated for a heart transplant by Joseph Rogers, MD.
experience in cardiac transplant—performing nearly 900 since
Not ready for surgery, Gullick wanted other options. A team
1985—means the new heart isn’t likely to fail her.
of Duke interventional cardiologists, electrophysiologists,
hristopher O’Connor, MD
C
Director, Duke Heart Center
Duke Heart Center
888-HRT-DUKE
armelo A. Milano, MD
C
Surgical Director, Cardiac Transplant
drian F. Hernandez, MD, MHS
A
Director, Outcomes Research
J oseph G. Rogers, MD
Medical Director, Cardiac Transplant
Top Program in the Country
Mechanical Circulatory Support: VADs
The Duke Heart Failure Program treats more
than 3,600 patients each year, using a proven
disease-management approach that has evolved
over the past decade to reflect advancements
in care.*
Duke’s mechanical circulatory support program
was among the first US programs approved by
the Centers for Medicare and Medicaid Services
and is certified by The Joint Commission
for destination ventricular assist devices (VAD).
In addition to having access to all the standard
FDA-approved devices for destination therapy,
Duke is involved in clinical trials, including
REVIVE-IT and ROADMAP. Duke was also the
leading enrolling center in the HeartWare DT
trial and one of only eight hospitals nationwide
offering FDA-mandated HeartMate II surgical
training in partnership with VAD manufacturer
Thoratec Corp., training surgeons from across
the country.
*Arch Intern Med. 2001 Oct 8;161(18):2223-8.
 #1 program in the country by research,
education, and clinical metrics
 First comprehensive Heart Failure
Disease Management Program
 #3 in LVAD and #4 in heart transplant
volumes nationally
 $40 million in NIH funding in 2011-2012
 More than 100 peer-reviewed publications
with 15 percent in high-impact journals
 2 FDA-approved biomarkers
Novel Heart Failure Same-Day Access Clinic
In 2012, Duke launched a same-day access
clinic for heart failure patients, providing
acute management of shortness of breath and
edema in early-stage heart failure. The clinic
offers intravenous diuretics and ultrafiltration
with the goal of reducing unnecessary hospital
admissions. This novel urgent care heart failure
clinic represents a patient-centered approach to
managing this chronic condition by providing
support during the critical transition out of the
hospital and in times of acute distress.
HEART FAILURE
READMISSION RATE
HEART TRANSPLANT
and VAD VOLUMES
Duke University Hospital
23.9%
2007
42
2008
2009
2010
2011
VAD
51
57
41
64
48
74
duke
61
83
60
Heart Transplant
ONE-YEAR HEART
TRANSPLANT PATIENT
SURVIVAL RATE
US
Data for July 1, 2008, to June 30, 2011.
These percentages were calculated
from Medicare data on patients discharged from Duke University Hospital
and do not include people in Medicare
Advantage plans or those without
Medicare. Source: Hospital Quality Alliance.
VAD SURVIVAL RATE
Duke University Hospital
RENEW Trial: Cell Therapy
Duke Heart Center cardiologist Thomas Povsic,
MD, is the national co-PI for the RENEW trial,
the first phase III pivotal study of a cell therapy
for cardiovascular indication seeking FDA approval in the United States. The study aims
to determine the effectiveness of targeted intramyocardial delivery of Auto-CD34+ cells
for increasing exercise time and reducing symptoms in patients with refractory angina and
chronic myocardial ischemia. Enrollment began
in April 2012.
24.7%
92.5%
90.2%
duke
US
Duke’s VAD survival rates exceed
the national average. In fact, our
longest surviving patient lived
more than seven and a half years
with pump support.
85%
78%
For adults receiving their first transplant
between 1/1/09 and 6/30/11. Visit
ustransplant.org for most current data.
One Year
DUKE
77%
68%
Two Year
US
Percent survival among primary mechanical circulatory support implants
between 06/23/06 and 6/30/11
2012 Report
15
Electrophysiology
Programs of distinction
Case Study
John Ponton, 66, underwent a successful lung transplant at
the donor pulmonary veins were sewn into his heart. Working
Duke in January, 2012. Within weeks, the former environmen-
carefully with cardiac imaging experts and the transplant team,
tal scientist was feeling short of breath—frightening for any-
James Daubert, MD, chief of cardiac EP, successfully ablated
one, but particularly for a man with new donor lungs. Ponton
the area and corrected the rhythm disorder.
was hospitalized with atrial fibrillation caused by fluid buildup
around his heart and lungs.
Since then, Ponton is doing well and recently celebrated his
37th wedding anniversary with wife, Terry. He attributes his
Duke Cardiologist Richard Becker, MD, managed to control
successful outcome to Duke’s expertise and cross-discipline
the AF with medication and Ponton was discharged. But by
coordination. The experience offered by Duke’s EP team is
early spring, the AF was no longer controllable. Ponton had
what makes theirs one of the most successful in the southeast.
developed atrial tachycardia, suspected to be located where
J ames P. Daubert, MD
Chief, Cardiac Electrophysiology
Duke Heart Center
888-HRT-DUKE
ugustus O. Grant, PhD, MB ChB
A
Cardiologist, Duke Heart Center
ristram D. Bahnson, MD
T
Director, Duke Center for Atrial Fibrillation
S ana M. Al-Khatib, MD, MHS
Clinical Research Director, Cardiac Electrophysiology
Highlights
Duke Center for Atrial Fibrillation
PROCEDURE VOLUMES
Duke Heart Center’s Electrophysiology Program is an international
arrhythmia referral center treating nearly 1,700 patients per year.
We offer the most comprehensive, expert, and highest-ranked EP
program in the Southeast.
Duke offers comprehensive medical-surgical, invasive, and noninvasive AF-related care.
Duke University Health System, CY11
 14 specially trained cardiac EPs
 Four state-of-the-art EP labs
 Team-approach model that includes EPs, cardiothoracic sur-
geons, dedicated NPs, PAs, RNs, technicians, patient educators,
and pharmacists
 Expertise in complex atrial fibrillation (AF) catheter ablation
procedures, as well as assessment and care of patients with
prior failed catheter or surgical ablation
Duke has the Southeast’s busiest implantable-device lead-extraction
programs and offers laser extractions in a fully hybrid OR with
an EP-cardiac surgical multidisciplinary team and ongoing clinical
trials in extraction.
We perform ventricular tachycardia ablations for cases ranging
from normal hearts to those postinfarction or those with cardiomyopathy and end-stage heart failure on LVAD or ECMO. Our team
has extensive experience in percutaneous epicardial ablation.
Adult Cardiovascular Genetics Program
Duke is one of the only centers in the Southeast to offer screening
for inherited cardiac rhythm disorders, such as the long QT and
Brugada syndromes, and to offer expertise in care management.
Cardiac Resynchronization Center
Duke EP offers new hope for heart failure patients with its cutting-edge research and technology. Our team has extensive invasive
clinical experience; a national physician-education program; and
a multidisciplinary Optimization Clinic for non-responders that
includes EP, heart failure (HF), and echocardiography specialists
working together to fine-tune patients’ implanted devices.
Duke Center for Prevention of
Sudden Cardiac Events in Athletes
Launched in 2011, our center adds EKG testing to the standard
physical exam given to all members of Duke University athletic
teams. In addition to detecting asymptomatic heart pathologies and
preventing premature deaths, we plan to assess the value of using
EKG on athletes and will mine the newly created data registry for
other trends.
Research
RAID—Investigator-initiated, NIH-sponsored trial aims to determine whether ranolazine administration in ICD patients will
decrease the likelihood of a composite arrhythmia endpoint, consisting of ventricular tachycardia or ventricular fibrillation requiring
anti-tachycardia pacing, ICD shocks, or resulting in death. The team
includes members of the Duke University Cooperative Cardiovascular Society consortium, who are in practice throughout the U.S.
2,800
Total EP Procedures
709
Ablations
1,452
ICDs
37
Lead Extractions
209
Biventricular Devices
393
Pacemakers
CALYPSO PILOT TRIAL—Duke investigator-initiated, multicenter pilot study comparing catheter ablation against antiarrhythmic drugs
for cardiomyopathy patients with ventricular tachycardia.
CABANA—Duke Clinical Research Institute-coordinated megatrial of catheter ablation versus antiarrhythmic drug therapy in AF
patients. Duke is the highest US enrollment site—and second highest
in the world—out of 140 sites.
PACE-RBBB—Duke investigator-initiated trial evaluating three
pacing treatment arms for patients with systolic heart failure and
right-bundle branch block.
FIRMAT-PAF—Intense investigation of the use of a novel system
capable of mapping of rotors to ablate atrial fibrillation.
2012 Report
17
Structural Heart
Programs of distinction
Case Study
Heart problems were the last thing that Simon Griffith, a
approach meant he could avoid the lengthy recovery associat-
52-year-old avid cyclist, expected. After biking some 200
ed with an open procedure. Glower made a small incision on
miles for charity, he grew concerned when a short ride left
the right side of Griffith’s chest and, through a series of other
him winded and fatigued. His cardiologist discovered a heart
small access points, used a robot to guide the necessary instru-
murmur, and an echocardiogram revealed significant mitral
mentation to the heart to make the repair.
regurgitation.
After five days in the hospital, Griffith returned home. After
Griffith was referred to Duke heart surgeon Donald Glower,
six weeks of recovery, he returned to biking. Duke’s exper-
MD, a renowned leader in minithoracotomy valve repair. Mitral
tise in mitral valve repair and replacement leads to not only a
valve repair instead of replacement meant Griffith could avoid
high-quality outcome, but ultimately a higher quality of life.
blood thinners or repeat surgeries and the minimally invasive
onald D. Glower, MD
D
Surgeon, Duke Heart Center
Duke Heart Center
888-HRT-DUKE
homas M. Bashore, MD
T
Clinical Chief, Cardiology
J . Kevin Harrison, MD
Director, Cardiac Catheterization
. Chad Hughes, MD
G
Director, Thoracic Aortic Surgery
The world leader in minimally invasive procedures
and pioneering research for two decades
ISOLATED MITRAL VALVE
REPAIR AND REPLACEMENT
VOLUMES
2007
47
60
2008
Transcatheter Aortic Valve Replacement (TAVR)
Minithoracotomy Valves
Duke is one of the top recruiting sites in the CoreValve pivotal
clinical trial of transcatheter aortic valve implantation (TAVI).
Our patient outcomes with CoreValve are among the best, earning
Duke one of the first US invitations to participate in SUR-TAVI,
an international trial assessing the appropriateness of TAVI for
patients with less severe aortic stenosis at intermediate risk for
open-heart surgery.
Duke is also one of the first US centers to implant a
valve within a valve successfully, reinforcing a failed
prosthetic valve with the Sapien implant. Our knowledge and experience working with both implant
systems available on the market and through clinical
Sapien Valve
trials means we are able to offer more treatment
options to a wider spectrum of patients.
With novel applications and expanded indications
for TAVR, patient selection is critical to a successful
outcome. Duke faculty coauthored the 2012 ACCF/
AATS/SCAI/STS Expert Consensus Document on
CoreValve
Transcatheter Aortic Valve Replacement and Duke
Clinical Research Institute will house the STS/ACC TVT Registry,
a national benchmarking tool to monitor patient safety and outcomes for TAVR. JACC 2012;59(13):1200-1254
Duke Heart Center is a global leader in minithoracotomy valve
repair and replacements. With more than 1,400 minithoracotomy
mitral procedures without femoral arterial cannulation, approximately 300 repeat mitral surgeries, and more than 250 tricuspid
surgeries, our faculty has the world’s highest volumes using this
sophisticated, small-incision technique. We have performed more
than 1,500 minithoracotomy mitral procedures, making us one
of the top three volume leaders in the world and are among the
nation’s top five volume leaders in minithoracotomy aortic valve
replacements, with more than 600 procedures.
Hypertrophic Cardiomyopathy
Duke offers a range of treatment options for patients diagnosed
with hypertrophic obstructive cardiomyopathy, including medical
management, catheter-based alcohol septal ablation and surgery. In
2011, we performed 23 septal myectomies. Our faculty are actively
researching advancements in therapies for patients with this genetic
condition; we are initiating a new study of medical therapy for
those with severe symptoms. We offer patients and their families
genetic counseling and education in collaboration with the Adult
Cardiovascular Genetics Clinic.
Adult Congenital Heart Disease
Percutaneous Mitral Valve Repair
As one of only 40 North American centers with access to MitraClip,
Duke has been a trial site for REALISM and EVEREST and will be
participating in COAPT, a new clinical trial evaluating the safety
and effectiveness of this device for patients with moderate-to-severe
mitral regurgitation.
Serving more than 1,200 patients annually, the Adult Congenital Heart Disease Program at Duke is a top referral center in the
Southeast and one of the world’s few major training programs in
adult congenital heart disease. Specially trained physicians include
two cardiothoracic surgeons who perform adult congenital procedures with volumes that rank in the top 10 nationally. The program
offers specialized interventional catheterization for defects that have
historically required open surgery, such as atrial septal defects; ventricular septal defects (VSD), including implantation of a muscular
VSD device; and patent foramen ovale.
2009
54
70
2010
2011
44
91
54
91
40
74
Repair
Replacement
ISOLATED AND PRIMARY
VALVE SURGERY VOLUMES
2007
213
261
2008
239
289
2009
250
306
2010
332
280
2011
342
276
Isolated
Primary
PRIMARY AND ISOLATED
MITRAL VALVE REPAIR AND
REPLACEMENT
2007
14%
86%
2008
14%
86%
2009
19%
81%
2010
7%
93%
2011
6%
94%
Conventional
Min. Invasive
All volumes are from Duke University
Medical Center, CY11
2012 Report
19
high-impact papers
High-Impact Basic, Translational, and Clinical Research Papers
Duke cardiovascular faculty generated more than 500 papers in peer-reviewed journals during the
2011-12 academic year. Publication highlights of our collaborative and Duke-led investigations include:
O’Connor CM, Starling RC, Hernandez
AF, et al. Effect of nesiritide in patients
with acute decompensated heart failure.
N Engl J Med. 2011 Jul 7;365(1):32-43.
Tricoci P, Huang Z, Held C, et al. Thrombin-receptor antagonist vorapaxar in acute
coronary syndromes. N Engl J Med. 2012
Jan 5;366(1):20-33.
Alexander JH, Lopes RD, James S, et al.
Apixaban with antiplatelet therapy after
acute coronary syndrome. N Engl J Med.
2011 Aug 25;365(8):699-708.
Weintraub WS, Grau-Sepulveda MV, Weiss
JM, et al. Comparative effectiveness of
revascularization strategies. N Engl J Med.
2012 Apr 19;366(16):1467-76.
Makkar RR, Fontana GP, Jilaihawi H, et
al. Transcatheter aortic-valve replacement
for inoperable severe aortic stenosis. N Engl
J Med. 2012 May 3;366(18):1696-704.
Duke Heart Center
888-HRT-DUKE
Chan PS, Patel MR, Klein LW, et al.
Appropriateness of percutaneous coronary intervention. JAMA. 2011 Jul
6;306(1):53-61.
Hillis LD, Smith PK, Anderson JL, et al.
2011 ACCF/AHA guideline for coronary
artery bypass graft surgery: executive
summary: a report of the American College of Cardiology Foundation/American
Heart Association Task Force on practice guidelines. Circulation. 2011 Dec
6;124(23):2610-42.
Shahian DM, O’Brien SM, Sheng S, et al.
Predictors of long-term survival after coronary artery bypass grafting surgery: results
from the Society of Thoracic Surgeons
Adult Cardiac Surgery Database (The
ASCERT Study). Circulation. 2012 Mar
27;125(12):1491-1500.
Whitlow PL, Feldman T, Pedersen WR, et
al. Acute and 12-month results with catheter-based mitral valve leaflet repair: the
EVEREST II (Endovascular Valve Edgeto-Edge Repair) high risk study. J Am Coll
Cardiol. 2012 Jan 10;59(2):130-9.
Wang TY, Angiolillo DJ, Cushman M, et
al. Platelet biology and response to antiplatelet therapy in women: implications
for the development and use of antiplatelet
pharmacotherapies for cardiovascular
disease. J Am Coll Cardiol. 2012 Mar
6;59(10):891-900.
Hernandez AF and Granger CB. Prediction
is very hard, especially about the future:
comment on ‘factors associated with 30day readmission rates after percutaneous
coronary intervention’. Arch Intern Med.
2012 Jan 23;172(2):117-9.
Williams JB, Peterson ED, Brennan JM,
et al. Association between endoscopic vs.
open vein-graft harvesting and mortality,
wound complications, and cardiovascular
events in patients undergoing CABG surgery. JAMA. 2012 Aug 1;308(5):475-84.
Patel MR, Dehmer GJ, Hirshfeld JW,
Smith PK, Spertus JA. ACCF/SCAI/STS/
AATS/AHA/ASNC/HFSA/SCCT 2012
appropriate use criteria for coronary
revascularization focused update: a report
of the American College of Cardiology
Foundation Appropriate Use Criteria
Task Force, Society for Cardiovascular
Angiography and Interventions, Society of
Thoracic Surgeons, American Association
for Thoracic Surgery, American Heart
Association, American Society of Nuclear
Cardiology, and the Society of Cardiovascular Computed Tomography. J Am Coll
Cardiol. 2012 Feb 28;59(9):857-81.
Lefkowitz, RJ. A tale of two callings. J
Clin Invest. 2011 Oct.3;121(10):4201-3
Califf RM and Kornbluth S. Establishing
a framework for improving the quality of
clinical and translational research. J Clin
Oncol. 2012 May 10;30(14):1725-6.
© Duke University Health System, 2012 9685
Allen LA, Stevenson LW, Grady KL, et al.
Decision making in advanced heart failure:
a scientific statement from the American
Heart Association. Circulation. 2012 Apr
17;125(15):1928-1952.
Hara MR, Kovacs JJ, Whalen EJ, et al.
A stress response pathway regulates DNA
damage through beta2-adrenoreceptors
and beta-arrestin-1. Nature. 2011 Aug
21;477(7364):349-53.
Duke Heart Center Resources
Join us in changing practice and changing lives. Stay in touch with the
latest advances and educational opportunities from Duke Heart Center
through these resources, available year-round:
Resources for Clinicians
Consultations and Referrals
Schedule appointments and access
information by calling:
 Duke Consultation and Referral Center
800-MED-DUKE (633-3853)
7:30 a.m. – 6:00 p.m. (EST)
 Duke Heart Center
888-HRT-DUKE (478-3853) or 919-681-5816
8:00 a.m. – 5:00 p.m. (EST)
 Duke University Hospital (After Hours)
Dial 919-684-8111 and ask for the
on-call cardiologist.
Acute Care Services
Continuing Medical Education
and Professional Development
Educational opportunities for clinicians,
educators, and researchers include:
 Office of Continuing Medical Education
Offers live courses; Web- and CD-ROMbased seminars; and remote real-time
training. Visit cme.mc.duke.edu and/or
cardiology.duke.edu, call 919-401-1200,
or e-mail cme@mc.duke.edu.
 Duke Clinical Research Institute’s
Clinical Medicine Series
Offers an array of courses and conferences.
Visit dcri.org/education-training/dcms or
e-mail dcms@dcri.duke.edu.
Resources for Patients
Support Duke Heart Center
 Duke Consultation and Referral Center
To find out how you can support
the Duke Heart Center’s mission to
achieve the highest level of excellence in patient care, research, and
education, please contact:
888-ASK-DUKE (275-3853)
 Heart Center Patient Support Program
Unites recovered Duke Heart Center
patients with current patients.
Dial 919-681-5031.
 Special Constituent Patient Program
Patient Navigators serve patients with
unique needs or who require special
assistance. Learn more at 919-684-6919.
 International Patient Center
L. Blue Dean
Executive Director, Development
512 S. Mangum Street, Suite 400
Durham, NC 27701
919-385-3159
blue.dean@duke.edu
Dial 919-681-3007 for details.
 Acute Chest Pain Clinic
Same-day appointments for patients
with urgent (not emergent) chest pain.
Area physicians can dial 888-HRT-DUKE
(478-3853) for details.
 Acute Myocardial
Infarction (MI) Hotline
When ECG indicates ST-elevation MI,
regional physicians and EMS personnel
can contact a Duke cardiologist, activate
the cath lab, and arrange transport to the
nearest Duke Heart Center or affiliate site
for PCI. Dial 919-627-0485 to learn more.
Clinical Trials
 Duke Clinical Research Institute
Interested researchers may visit
dcri.org/trial-participation.
 Clinical Trials Networks Best Practices
For clinical research resources, visit
ctnbestpractices.org. Co-sponsored
by DCRI and NIH.
 Duke Heart Center
Visit dukehealth.org/clinicaltrials
for partial lists of current trials.
Visit dukemedicine.org/heartreport for a
list of Duke heart care-related Web sites.
Chan
ging
Visit dukemedicine.org/heartreport for a PDF of this report. pra
C
ChantiCe
While care was taken to ensure the accuracy of data and
lives ging
information in this publication, any necessary updates
Access the Duke Heart Center Report Online
or corrections will also be available via this Web page.
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Repo
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DUMC 3525 Durham, NC 27710
888-HRT-DUKE
800-MED-DUKE
dukehealth.org/heart
Ranked seventh among the nation’s best
heart programs by U.S.News & World
Report for 2012-2013—and in the top
ten since 1993.
All three Duke University Health System
hospitals have earned Magnet status for
nursing excellence from the American
Nurses Credentialing Center.
2012 Rising Star award from University
HealthSystem Consortium in recognition
of significant improvements and exemplary performance in patient safety, mortality,
and clinical effectiveness. Duke University
Hospital is one of only four hospitals
nationally to win the award.
uke University Hospital recognized as a
D
2012 Top Performer by The Joint Commission on key quality measures including
heart attacks, heart failure, and surgical
care. Just 18 percent of eligible U.S.
hospitals received the recognition.
Duke University Medical Center ranked
#8 among America’s Best Hospitals by
U.S.News & World Report, 2012-2013.
Duke Heart Center faculty member and
Howard Hughes Medical Institute investigator Robert J. Lefkowitz, MD, shared
the 2012 Nobel Prize in Chemistry for
his discovery of G protein-coupled cell
receptors, which are the target of some
40 percent of pharmaceuticals.
For the fifth consecutive year, Duke University Hospital received the Get With the
Guidelines—Heart Failure Gold Plus Quality Achievement Award from the American
Heart Association. The awards recognizes
exceptional performance on adherence to
the guidelines and quality measures.
American Heart Association’s 2012 Mission: Lifeline® Bronze Quality Achievement
Award in recognition of Duke University’s
Hospital’s commitment and success in
implementing a high standard of care
for heart attack patients.
All three Duke University Health System
Hospitals received Platinum Performance
Achievement Awards for their performance on the ACTION Registry-GWTG
indicators for evidence-based treatment
of AMI patients.