First Coast Cardiovascular Institute

In Transition To

Jacksonville Clinic !

www.firstcoastcardio.com

CARDIOVASCULAR UPDATES

CARDIOVASCULAR UPDATES

Yazan khatib, MD FACC, FSCAI, FSVM

!President

Director of Limb Salvage & Endovascular Interventions !

First Coast Cardiovascular Institute

First Coast Cardiovascular Institute

Most our patients come from Florida, Yet many live all over The U.S.

FCCI

Zip Codes of > 50 patients

First Coast Cardiovascular Institute

4

Areas of Clinical Excellence

Comprehensive Cardiovascular Care

Limb Salvage & Amputation Prevention Institute

Advanced Stroke Prevention Cardiovascular Research

Endovascular Interventions Outreach Services

First Coast Cardiovascular Institute

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Long Tradition of Achieving & Maintaining the Highest Levels of Accreditation

First Coast Cardiovascular Institute

6

History of being the First

Carotid Stenting ➢ First to perform carotid stenting in

North East Florida

The First to Promote Endovascular Limb Salvage

As a dedicated sub-specialty

Endovascular Intervention

Comprehensive Venous Clinic Research Department

First Coast Cardiovascular Institute

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Carotid Stenting Outcomes

Patient Survival by Ankle-BrachialIndex in Cardiovascular Health

Study

0.6

0.7

0.8

0.9

1

0 1 2 3 4 5 6

YEARS

PATI

ENT

SURV

IVAL

ABI>1.0

ABI: 0.9-1.0

ABI: 0.8-0.9

ABI<0.8

Newman et al ATVB 1999;19; 538-545.

Even “Mild” PAD associated with increased mortality.

Five Year Mortality RatesPVD Versus Cancer

Five Year Mortality Rates

0% 20% 40% 60% 80% 100%

Breast cancer

PAD

Colon/Rectal

Lung Cancer

*Criqui M. Presentation: Vascular Medicine of the Lower Extremities at theAmerican Diabetes Association’s Scientific Sessions June 1999

PAD all comers outcome

Five Year Mortality RatesPVD Versus Cancer

Five Year Mortality Rates

0% 20% 40% 60% 80% 100%

Breast cancer

PAD

Colon/Rectal

Lung Cancer

*Criqui M. Presentation: Vascular Medicine of the Lower Extremities at theAmerican Diabetes Association’s Scientific Sessions June 1999

Patients with foot ulcers

Prior Heart Attack

No Prior Heart Attack

Wt Gain Diabetes, High Cholesterol

Tobacco Cessation ANTI PLATELET RX (ASA, PLAVIX) “Blood

Thinners” Cholesterol Control LDL<70 & TG <150 BP Control <140/90 (<130/80 IN DM) Weight Control Sugar Control

It not all bad news Much of this is preventable/

reversible

Reducing CV risk

Proud of our own achievement reducing amputations by half

Outcome Disparity in Duval County 2006

http://www.FloridaHealthFinder.gov/QueryTool/Default.aspx?DataType=Inpatient “Crude” Salvage Rates by hospital Duval county 2006 DOH data

SUMMARY

• Cardiovascular disease remains under diagnosed • Early diagnosis is feasible with limited cost • Early prevention and treatment can alter the long term outcome and reverse the poor prognosis • Obesity & Diabetes Epidemic must be addressed • New Technological & Medical Advances are available and still largely under utilized.