Jonathan Hsu, MD, Peter Ganz, MD and John S. MacGregor, MD.
This article was originally published in the Winter 2009 issue of the San Francisco General Hospital Foundation News.
any of us have heard it before: Coronary heart disease is the leading
cause of death in the United States for men and women. It follows, then,
that diagnosing heart disease early, treating it with the highest
quality of care and working to prevent its onset saves lives. At San
Francisco General Hospital and Trauma Center (SFGH), the Division of
Cardiology is charged with doing just that.
Headed by renowned cardiologist Dr. Peter Ganz, the division features three distinct but related functions: treatment, education and research.
"San Francisco General has one of the best cardiology divisions in the country for clinical care, for teaching and discovery," says Ganz. "We provide healthcare at the highest level. We train the future leaders in cardiovascular medicine. And we’re doing cutting edge research."
Cardiovascular disease refers to diseases of the heart or blood vessels (arteries and veins). The most common cause is atherosclerosis, commonly known as "hardening of the arteries," which occurs when fatty material and plaque build up within the walls of the arteries.
Patients served at SFGH often present a higher risk for heart disease than those in the general population.
"We have a greater percentage of patients with HIV or diabetes than most private hospitals. And our patients are more likely to be cigarette smokers or abuse other substances," explains Ganz. "We provide them with the highest quality compassionate care."
SFGH sees patients with an extraordinary breadth of heart diseases, including diseases of the heart valves that become either too narrow (valves do not open) or too leaky (valves do not close) or diseases of the heart muscle that manifest as congestive heart failure. Often, SFGH doctors treat patients who present with advanced symptoms.
Heart attacks are all too common in the United States, occurring at the rate of about 1.1 million each year. Many such patients are seen in the emergency department at SFGH. When a heart attack occurs, every minute counts. In recent years, the SFGH Division of Cardiology has improved its ability to treat heart attacks quickly and effectively. Previously, patients had to be transferred to another hospital, necessitating undue delays. Now, when someone is having a heart attack, a specialized team of cardiologists and nurses is promptly mobilized.
Dr. Ganz discusses a case with Maeve Reid, RN.
"Typically within 90 minutes after the patient is brought to the emergency department, our specialists can use angioplasty and stents to re-open the occluded coronary artery that caused the heart attack," says Ganz. "This rapid response saves heart muscle and lives. Eighty patients with heart attacks will be treated in this manner at SFGH this year alone, and we expect a high success rate."
An affiliate of the University of California, San Francisco (UCSF), SFGH is also renowned for cutting-edge research. Building on its national leadership role in the field, the SFGH Cardiology Division launched the Center for Excellence in Vascular Research in November of 2008. The center’s goal is to advance discovery in the prevention and treatment of human vascular disease. One of several targeted areas focuses on HIV and cardiovascular disease.
"HIV is now recognized as a risk factor for several cardiovascular diseases. As patients with HIV are surviving into old age due to improved treatments, they are prone to developing illness that come with aging, including atherosclerosis, at a rapid pace," explains Ganz. "How do we keep these patients healthy and alive?
"Likewise, SFGH sees many patients with rheumatoid arthritis, which is an inflammatory condition affecting the joints. We know that inflammation anywhere within the body can hasten atherosclerosis and leave patients prone to heart attacks. The more we understand the interplay between the body’s various organ systems, the more effectively we can prevent heart disease."
Other areas SFGH researchers are studying are the effects of second-hand smoke on heart disease, and the effects of obesity and bariatric surgery on cardiovascular risk.
"Many morbidly obese patients have diabetes," Ganz explains. "Often, that resolves after bariatric surgery (popularly known as gastric bypass). But will bariatric surgery reduce their risk for adverse cardiovascular outcomes? That’s what we are investigating now."
He adds that SFGH researchers are also engaged in identifying biomarkers for cardiovascular disease.
"Molecules that are associated with a disease may appear in the blood even before the disease presents. These are known as biomarkers," Ganz explains. "When we understand these biomarkers, we can identify and forestall diseases before they occur."
To that end, SFGH researchers partner with leading biotech companies throughout the Bay Area and elsewhere. Their work is enabling them to develop new platforms for testing biomarkers. "Now we can do some of our testing of biomarkers in patients’ homes," says Ganz. "It’s perfect for those with chronic heart conditions."
The treatments in conditions like congestive heart failure might be tailored according to biomarker levels that precisely indicate the severity of this illness. Treatment based on biomarkers may improve outcomes and reduce the need for hospitalizations.
Ganz is quick to emphasize the collaborative efforts and extraordinary relationships between researchers both within SFGH and between SFGH and UCSF.
"They make for natural collaborations," he says. "The Center for Excellence is not just doing research within cardiology, but collaborates with the Positive Health Program, endocrinology, rheumatology, internal medicine, pharmacology, obstetrics and gynecology and more," Ganz adds. "This may be a county hospital, but it doesn’t mean we can’t muster the resources and know-how for cutting-edge research."
As an example, he cites studies linking the risk of cardiovascular disease with rheumatoid arthritis. Dr. John Imboden, Chief of the Division of Rheumatology, has already established a group of 500 patients at UCSF with rheumatoid arthritis who are followed meticulously; but the investigations of these subjects have not specifically focused on cardiovascular diseases.
"It certainly makes sense for us to establish collaborations and draw on existing population than to start over each time. SFGH is a perfect environment for such collaborative work," says Ganz. In addition to SFGH being a leader in cardiac clinical care and research, the hospital is also known as one of the best in teaching facilities in the country and a favorite place for trainees, from medical students to residents and cardiology fellows.
"San Francisco General Hospital is a great place for people to learn. Our fellows and residents are drawn to caring for the underserved, the indigent and various ethnic groups" says Ganz. "They’re more closely involved in the care of patients here than they would be in a private setting. Even though our cardiology faculty is relatively modest in size, it’s a very distinguished group of national leaders in their fields."
Ganz cites Drs. Elliot Rapaport, Melvin Cheitlin, Nora Goldschlager, Neal Benowitz and David Waters as pioneers and leaders in their fields of interest who have made key contributions to cardiology for many years. He adds that Drs. Ann Bolger, Mary Gray, Priscilla Hsue, John MacGregor and Ramin Farzaneh-Far have also earned national reputations as first-class clinicians, investigators and teachers.
"Furthermore," Ganz says, "the entire cardiology division owes a debt of gratitude to its devoted support staff that shares in the vision, to the dedicated volunteer faculty and to the Department of Medicine under the leadership of Drs. Talmadge King and Neil Powe for its steadfast support."
Ganz joined San Francisco General Hospital in January 2008, after nearly 25 years at Brigham and Women’s Hospital, a teaching affiliate of Harvard Medical School.
"If there are two places nationally I’d single out for quality of patient care, devotion to education and innovation in cardiovascular medicine, they would San Francisco General and the Brigham," Ganz says.
While his tenure at SFGH has been relatively short, it is "incredibly gratifying," he adds.
"Here in San Francisco, we have an extraordinary population being served by some of the brightest and most dedicated professionals in the world. Our work is helping people live longer, healthier lives."
