AHN Physicians Perform Innovative Procedure to Treat Severe, Uncontrolled Asthma
Wednesday, November 2nd, 2016
Bronchial Thermoplasty Helps Moon Township Woman Breathe Easier after Long Struggle with Debilitating Asthma
PITTSBURGH, Pa. — Doctors at Allegheny General Hospital (AGH), a part of Allegheny Health Network, are the only healthcare providers in Pittsburgh offering an innovative, alternative technique to treat severe asthma that cannot be well controlled with medicines.
Jennifer McBride, a 38–year-old resident of Moon Township, was among the first patients in Pittsburgh to recently undergo bronchial thermoplasty (BT) at AGH. During the procedure, excess smooth muscle is removed from the airways of the lung to reduce severe asthma attacks. The new therapy is being performed by AGH pulmonologists Marvin Balaan, MD and Antonios Zikos, MD, who work in consultation with Deborah Gentile, MD, Director of Allergy and Asthma Clinical Research in AHN’s Division of Pulmonary, Allergy and Critical Care Medicine.
Doctors at AHN’s Saint Vincent Hospital in Erie also perform the new procedure.
“It is very exciting to have a viable non-drug treatment for asthma, because medication alone does not work for every patient,” said Dr. Balaan, System Division Director of Pulmonary and Critical Care at AHN.
Boston Scientific’s Alair™ bronchial thermoplasty (BT) system is the first non-medical treatment approved by the Food and Drug Administration (FDA) for treating severe asthma in adults when inhaled corticosteroids and long-acting beta-agonists such as Advair, Symbicort and Dulera do not provide good asthma management. BT does not replace maintenance medications, but works with the patient’s medication to provide long-term stability in symptoms and lessen severe attacks.
“Asthma is a chronic disease with a high burden of recurring medical costs and a negative impact on quality of life,” said Dr. Gentile. “Bronchial thermoplasty could reduce the impact of lifelong medical management of asthma for many patients who don’t achieve good results with medications alone.”
During an asthma attack, smooth muscle in the airways constricts, making it more difficult to breathe. BT uses mild heat to reduce the amount of smooth muscle in the airways and minimize their narrowing during asthma attacks.
“No incisions are required for the procedure. The BT device is introduced into the lungs with a bronchoscope inserted through the nose or mouth,” said Dr. Zikos. “BT is performed under moderate sedation or general anesthesia in three separate treatments scheduled three weeks apart. Each session lasts approximately 30 minutes and focuses on a different area of the lungs until all areas are treated.”
McBride’s asthma had become so severe that she estimates she visited the emergency department or was admitted to the hospital “40 to 50 times over the last four years,” she said. “It got to the point where everyday things became hard for me. And there was no simple cold; it would turn into bronchitis or pneumonia. With a husband and two teenage daughters, I just couldn’t handle that anymore.
“Since I finished the BT procedures, though, I can do things I couldn’t do before. I don’t use my rescue inhaler as much – before, I’d use it just to get up the stairs,” McBride added. “I can get through the day without having to stop and catch my breath at work. And I just got over a common cold that, for the first time in years, didn’t turn into something worse.”
“BT is a valuable tool in our arsenal to help patients with severe asthma find relief and regain their quality of life,” said Dr. Zikos. “With documented poor air quality and an unusually high asthma rate in our region, BT could play an instrumental role in treating Pittsburgh’s asthma epidemic.”
According to the American Lung Association’s annual “State of the Air” report, the Pittsburgh metro area ranked as the 14th-most polluted area in the country for daily fine particle emissions and the eighth worst for annual particle pollution. Particulate matter pollution is tied to multiple illnesses, including asthma.
The Asthma and Allergy Foundation of America (AAFA) also ranks Pittsburgh as the 27th-most challenging U.S. city in which to live with asthma, based on factors such as high level of exposure to known asthma triggers such as poor outdoor air quality, indoor allergen exposure, tobacco smoke exposure and high poverty rates.
Nearly 25 million Americans live with asthma. According to the AAFA, asthma contributes to more than 14 million doctor visits, 2 million emergency room visits, almost 500,000 hospitalizations and nearly 4,000 deaths each year. The annual cost of asthma is about $56 billion, including more than $50 billion in direct costs, such as hospital stays, and nearly $6 billion in indirect costs, such as lost wages from illness or death.
The VITAL Innovation Program of Highmark Health helped to bring BT to AHN as part of its commitment to supporting the study and availability of novel technologies and therapies in the community that may offer better solutions for chronic diseases.
Launched in 2015, the VITAL program was designed to provide the missing link between FDA approval of a new technology and its full reimbursement by commercial insurers. VITAL is currently supporting the study of several additional leading-edge medical breakthroughs at AHN hospitals, including: the LINX® Reflux Management System for treating patients with gastro-esophageal reflux disease (GERD); the Avinger Ocelot™ lumivascular and Pantheris™ atherectomy systems to treat peripheral artery disease; the HeartFlow non-invasive diagnostic technology that offers physicians insight into both the extent of a patient’s coronary arterial blockage and the impact the blockage has on blood flow; and the Freespira Breathing System for patients who suffer from panic disorder.
AHN First in the Region to Use Innovative Technology in Treating Peripheral Artery Disease
May 23, 2016
PITTSBURGH, Pa. – A team of cardiovascular surgeons at Allegheny General Hospital (AGH), part of Allegheny Health Network (AHN), has become the first in the region to use a groundbreaking new technology to provide relief for people suffering from peripheral artery disease (PAD). Highmark Health’s VITAL Innovation Program partnered with AHN to introduce the technology to the Pittsburgh market.
Affecting nearly 20 million adults annually in the U.S., PAD is caused by a build-up of plaque that blocks blood flow in the arteries of the legs or feet. Until recently, physicians treating PAD through interventional means relied on the use of X-ray and a touch-and-feel approach to guide their way through the arteries to the area of obstruction. Now, through an advanced imaging tool called optical coherence tomography (OCT), physicians are able to navigate through arteries more effectively and safely to remove blockages and achieve the best possible outcome for the patient. OCT is the hallmark of innovative catheter instruments developed by California-based Avinger – called the Ocelot™ lumivascular and Pantheris™ atherectomy systems – that are being used by the AGH team.
“Previously, the way we treated PAD with catheters was a bit like driving down your street in the dark,” said Satish C. Muluk, MD, Director of the Division of Vascular Surgery and Vice Chair of the Department of Thoracic and Cardiovascular Surgery at AHN. “You might know where you’re going, but you can’t see everything along the way. Using Ocelot and Pantheris, however, is like turning on the headlights.
“We now have the ability to clearly see our way through the artery. This means there is less risk of damaging the artery walls, which can lead to an aggressive healing-and-scarring process that increases the risk of restenosis, or a re-narrowing of the artery after treatment.”
Using Pantheris, which the U.S. Food and Drug Administration (FDA) approved in March, physicians can see and remove plaque simultaneously during an atherectomy, a minimally invasive procedure that involves cutting plaque away from the artery and clearing it to restore blood flow. For a complete blockage of the artery, known as a chronic total occlusion (CTO) and something that is more common in older patients, AGH vascular surgeons are also now able to use the Ocelot catheter.
“We’ve successfully treated CTOs with the Ocelot catheter that we otherwise would not have been able to manage interventionally,” said Bart Chess, MD, an AGH vascular surgeon. “With some patients, we will use the Ocelot catheter in conjunction with Pantheris. If there is not a total blockage, then we may only need to use Pantheris.”
Results from a 130-patient clinical trial of the Pantheris device demonstrated a vessel restenosis rate of just 8% and no vessel perforation, clinically significant dissection or late aneurysm.
Often misinterpreted as the normal signs of aging, symptoms of PAD include painful cramping, numbness or discoloration in the legs or feet. PAD can become so severe and difficult to address with traditional treatments that patients and physicians often resort to undergoing invasive bypass surgeries, which can result in additional health risks and lengthy, painful recoveries. In severe cases, patients often face limb amputation.
Hospitalization costs for PAD exceed $20 billion per year, largely because the disease is often diagnosed late. This high cost is one of the reasons Highmark Health, the parent company of AHN, chose to use its VITAL program to explore ways of improving patient outcomes from the disease in the most cost-effective and efficient manner.
“The mission of the VITAL Innovation Program is to leverage Highmark Health's position as one of the largest integrated health care delivery and financing systems in the nation,” said David Holmberg, President and Chief Executive Officer of Highmark Health. “We developed the VITAL program to produce scientific data and accelerate the pace at which novel technologies and therapies are offered to patients.”
Launched in 2015, the VITAL program is designed to provide the missing link between FDA approval of an innovative technology and its full reimbursement by commercial insurers. VITAL is currently supporting the study of several additional leading-edge medical breakthroughs at AHN hospitals, including the LINX® Reflux Management System for treating patients with gastro-esophageal reflux disease (GERD); the HeartFlow non-invasive diagnostic technology that offers physicians insight into both the extent of a patient’s coronary arterial blockage and the impact the blockage has on blood flow; and the Freespira Breathing System for patients who suffer from panic disorders and symptoms of panic.
About Highmark Health
Highmark Health, a Pittsburgh, PA based enterprise that employs more than 35,000 people nationwide and serves 40 million Americans in all 50 states, is the third largest integrated health care delivery and financing network in the nation. Highmark Health is the parent company of Highmark Inc., Allegheny Health Network, and HM Health Solutions. Highmark Inc. and its subsidiaries and affiliates provide health insurance to 5.3 million members in Pennsylvania, West Virginia and Delaware as well as dental insurance, vision care and related health products through a national network of diversified businesses that include United Concordia Companies, HM Insurance Group, Davis Vision and Visionworks. Allegheny Health Network is the parent company of an integrated delivery network that includes eight hospitals, a community-based network of physician organizations, a group purchasing organization, ambulatory surgery centers, and health and wellness pavilions in western Pennsylvania. HM Health Solutions focuses on meeting the information technology platform and other business needs of the Highmark Health enterprise as well as unaffiliated health insurance plans by providing proven business processes, expert knowledge and integrated cloud-based platforms. To learn more, please visit www.highmarkhealth.org or www.vitalinnovationprogram.org or contact Highmark Health at 412-544-0968.
VITAL program partners with Allegheny Health Network and HeartFlow to evaluate a novel 3D technology
April 29, 2016
New modeling tool aids physicians’ ability to identify best treatment for patients with coronary artery disease
Pittsburgh PA and Redwood City, CA (April 25, 2016) – Highmark Health, Allegheny Health Network (AHN), and HeartFlow, Inc. announced today that they are partnering to evaluate a novel non-invasive diagnostic technology that offers physicians insight into both the extent of a patient’s coronary arterial blockage and the impact the blockage has on blood flow. The partnership is part of Highmark Health’s VITAL (Verification of Innovation by Testing, Analysis and Learning) Innovation Program.
The HeartFlow Analysis uses images derived from a standard, non-invasive coronary CT angiogram (cCTA); the U.S. Food & Drug Administration (FDA)-cleared product creates a personalized, digital 3D model of each patient’s coronary arteries. Powerful computer algorithms then solve millions of complex equations to assess the impact of blockages on blood flow. This information aids physicians to determine the appropriate course of action for each patient.
“Traditionally, our options for diagnosing coronary artery disease included either a non-invasive stress test or an invasive heart catheterization.” said Moneal Shah, MD, a cardiologist at AHN and the lead investigator of this program. “With the technology from HeartFlow, we are essentially combining the information provided by a heart catheterization and a stress test through a simple non-invasive test. This is the first non-invasive technology to do this and has the potential to reduce the need for invasive testing.”
Coronary artery disease, also called coronary heart disease, is the leading cause of death for both men and women in the United States. Coronary artery disease develops when the arteries leading to the heart narrow, often because of the buildup of plaque in the vessel walls. The coronary narrowing can reduce blood flow to the heart, causing chest pain, heart attacks and death. In the United States, an estimated 16.3 million adults suffer from coronary artery disease and it is the leading cause of death worldwide, killing approximately 3.8 million men and 3.4 million women each year. 1
AHN cardiologists already have reported that the HeartFlow Analysis has provided more definitive clinical information that led to an improved treatment strategy for several patients. Recently, a 78-year-old male dealing with chest pain for more than a year had two normal stress tests, but his symptoms persisted. Physician review of the coronary CT and HeartFlow analysis indicated the patient had extensive disease that would require a revascularization with two stents. Meanwhile, a 58-year-old female patient with a history of hypertension had an abnormal stress test but was able to avoid an invasive angiography when physician review of the HeartFlow Analysis indicated that her disease was not severe and medical management would be the optimal treatment.
“These examples illustrate how this innovative technology can potentially assist cardiologists to improve their diagnostic skills so that the right care can be prescribed to the right patient,” said Srinivas Murali, MD, Director of AHN’s Cardiovascular Institute.
Through the VITAL program, payers are able to understand the full impact of new technologies on their members without changing insurance medical policy prematurely. Additionally, providers gain early access to novel technologies and a first-hand understanding of their impact on patients. In this way, technology vendors have the opportunity to prove the benefits of their new innovations to patients, providers and payers.
“VITAL’s mission is to leverage Highmark Health's position as one of the largest integrated health care delivery and financing systems in the nation in order to accelerate the pace with which novel technologies and services are made available to the public,” stated David Holmberg, President and CEO, Highmark Health. “Our members and patients will be afforded access to safe new technologies that increase the quality of care and create positive patient outcomes without undue financial burden.”
About Highmark Health
Highmark Health, a Pittsburgh, PA based enterprise that employs more than 35,000 people nationwide and serves 40 million Americans in all 50 states, is the third largest integrated health care delivery and financing network in the nation. Highmark Health is the parent company of Highmark Inc., Allegheny Health Network, and HM Health Solutions. Highmark Inc. and its subsidiaries and affiliates provide health insurance to 5.3 million members in Pennsylvania, West Virginia and Delaware as well as dental insurance, vision care and related health products through a national network of diversified businesses that include United Concordia Companies, HM Insurance Group, Davis Vision and Visionworks. Allegheny Health Network is the parent company of an integrated delivery network that includes eight hospitals, a community-based network of physician organizations, and a group purchasing organization, ambulatory surgery centers, and health and wellness pavilions in western Pennsylvania. HM Health Solutions focuses on meeting the information technology platform and other business needs of the Highmark Health enterprise as well as unaffiliated health insurance plans by providing proven business processes, expert knowledge and integrated cloud-based platforms. To learn more, please visit www.highmarkhealth.org or www.vitalinnovationprogram.org or contact Highmark Health at 412-544-0968.
About Allegheny Health Network
Allegheny Health Network is an integrated health care delivery system serving the western Pennsylvania region. The network is comprised of eight hospitals, including Allegheny General Hospital (its flagship academic medical center), Allegheny Valley Hospital, Canonsburg Hospital, Forbes Hospital, Jefferson Hospital, Saint Vincent Hospital, Westfield Memorial Hospital and West Penn Hospital; a research institute; Health + Wellness Pavilions; and a health care group purchasing organization. The network employs approximately 17,000 people, including more than 2,100 physicians on its medical staff. The network also serves as a clinical campus for both Temple University School of Medicine and Drexel University College of Medicine.
HeartFlow Inc. is a personalized medical technology company seeking to transform the way cardiovascular disease is diagnosed and treated. The company’s HeartFlow FFRCT Analysis is the first available non-invasive solution that enables a physician to more accurately evaluate whether a patient has significant coronary artery disease (CAD) based on both anatomy and physiology. The novel solution, which produces a model of the patient’s coronary arteries, is well positioned to become an integral part of the standard of care for patients who are at risk for CAD because of its potential to improve clinical outcomes, improve the patient experience and reduce the cost of care. The HeartFlow Analysis is being utilized globally and is commercially available in the United States, Europe, Canada and Japan. For more information visit www.heartflow.com. Learn more about Heartflow PLATFORM trial results here: http://www.heartflow.com/wp-content/uploads/2015/08/CCM-100-083-A-HeartFlowPLATFORMACCRelease160328-final.pdf 1. American Heart Association
Allegheny Health Network
Chris B. Ernst
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