Addressing Cardiac Care Disparity in Niagara

“George,” a 56-year-old unemployed welder, was complaining of chest pain when he walked into the emergency room at Niagara Falls Memorial Medical Center. His unemployment assistance expired, he was living on public assistance and barely getting by in a drafty apartment with an aging, undependable furnace.

“Sometimes it works and sometimes it doesn’t,” he said. “It all depends if the landlord finds time to repair it.”

Doctors who evaluated George found he had dangerously high blood pressure and admitted him. He requested a visit from the medical center’s health home director/care manager Vicki Landes, who was meeting with him for the first time when a cardiologist stopped by to say he would discharge George with orders to report to a Buffalo hospital for a cardiac angiogram.

George was willing to go but there was a snag. He didn’t have anyone to accompany him home from the hospital after the procedure.

He asked to get the angiogram done at a later date when he could get someone to bring him home. He was released from the hospital but, despite Vicki’s urging, never had the procedure done. He died three months later.

“The people who need this care the most are getting it the least,” said Memorial Medical Center President & CEO Joseph A. Ruffolo. “That’s why our collaboration with Erie County Medical Center and Kaleida is so vitally important.”

Erie County Medical Center, Kaleida Health and Niagara Falls Memorial Medical Center recently announced a three-point plan to bring lifesaving cardiac care closer to home for people like George.

Called the Full Circle of Heart Care project, the collaborative effort calls for ECMC to decertify its license for one of its three cardiac catheterization labs and transfer the license to Kaleida Health. Kaleida’s Gates Vascular Institute would then establish a cardiac catheterization lab at Memorial’s Heart Center of Niagara.

The Niagara Falls facility will be staffed and operated by Kaleida’s Gates Vascular Institute and perform coronary angiograms and interventional procedures such as cardiac stenting and angioplasty. The transfer and establishment of the cardiac cath lab in Niagara is subject to New York State Department of Health approval.

“The lack of access to cardiac catheterization services, largely attributed to a lack of transportation, has created significant disparities in heart care for African-Americans and people from low income households in Niagara County,” Ruffolo said.

Niagara County’s cardiovascular mortality rate is one of the highest in the state and among the highest in the country. Nearly one in three county residents dies from heart disease – and the death rate among African Americans is 23 percent higher than the county’s rate.

“The rate of cardiac catheterization care for whites is twice that for African Americans,” Ruffolo said. “And while we know people from low-income households are much more likely to suffer from high blood pressure, high cholesterol and heart attack, the rate of cardiac catheterization for whites is nearly three times the rate for Medicaid beneficiaries.”

Ruffolo noted that Niagara County is the second most populated county in Western New York.

“Despite that fact, the lack of a cardiac catheterization laboratory forces Niagara County residents to travel a considerable distance for that service. This lack of accessibility results in an excessive time lapse – typically 125 minutes – between onset of a heart attack and interventional treatment,” Ruffolo said.

Kaleida President & CEO Jody Lomeo said the three-way collaboration between health systems will benefit the entire region.

“We are proud to be part of this unprecedented collaboration to improve access to lifesaving cardiac care in an area where it is clearly lacking,” Lomeo said. “This is all about bringing the Gates Vascular Institute – a top 15 program in the nation – right into the community and improving the quality of care for patients across the eight counties of Western New York.”

The Full Circle of Heart Care project is designed to meet the state’s Delivery System Reform Incentive Payment (DSRIP) Program goal of fundamentally restructuring the health care delivery system by reinvesting in the Medicaid program with the primary goal of reducing avoidable hospital use by 25 percent over five years.

“ECMC is proud to be part of this three-way historic collaboration,” said Richard C. Cleland, President/Chief Operating Officer and Interim Chief Executive Officer of the

Erie County Medical Center Corporation. “We are pleased to transfer the license to this valuable resource so it can employed where most needed — driving improvement in the region’s health status without imposing burdensome long term costs to the healthcare system.”

Cleland noted that ECMC is lead applicant for Millenium Collaborative Care, a DSRIP Performing Provider System (PPS) that includes Kaleida and Niagara Falls Memorial.

“Our community through DSRIP will be addressing health disparities throughout Western New York. This is a great start and an example of how DSRIP will make a difference in our community’s health care,” Cleland said.

The participating parties will seek $1.05 million in DSRIP capital funding for the $2.1 million catheterization lab project with Kaleida Health and Niagara Falls Memorial contributing about $550,000 each.

In addition to eliminating barriers to cardiovascular care that create significant health disparities among African Americans and Medicaid beneficiaries residing in Niagara County, the Full Circle of Heart Care will:

  • Improve the management of cardiovascular diseases through the use of best practices, employing evidence based strategies and a team model of care to address heart disease among Medicaid beneficiaries.

    Strategies will include implementation of a comprehensive screening program for cholesterol, blood pressure and smoking along with care management services for all adults receiving services at Memorial’s primary care sites.

Free access to blood pressure monitors will be provided at primary care sites and key community locations and identified tobacco users will receive cessation intervention.

  • Wage a strong and sustained campaign to prevent heart disease. Memorial will join with ECMC and Kaleida in promoting heart health education using the Centers for Disease Control and Prevention’s Million Hearts Campaign and other evidence based social marketing materials to educate and link patients to healthy eating, exercise and smoking cessation programs.

“Taken together these three strategies will involve healthcare providers including mental health providers, agencies serving the developmentally disabled, churches and other community organizations in a comprehensive and collaborative approach to better heart health in our communities,” Ruffolo said.