North General Hospital, in Conjunction With Mount Sinai Medical Center, Implements Diagnostic CCL for East Harlem Residents

D.G. is a 68-year-old African-American female who presented to the North General Hospital Emergency Department (NGH ED) with chest pain that has been present intermittently for several months. The chest pain that drove her to the NGH ED was different, however. It woke her from sleep and was not relieved with sublingual nitroglycerin. She was being treated medically in another New York City hospital for her angina and other medical problems such as non-insulin dependant diabetes, hypertension, and hypercholesterolemia. D.G. also complained about bilateral leg pains that have been bothering her for several months. She was a heavy smoker for many years, but had quit only a year ago. Subsequently, she was admitted to the telemetry unit and referred for cardiac catheterization at North General Hospital. The cardiac cath revealed significant coronary artery disease. She was transferred to Mount Sinai Medical Center for coronary intervention and further peripheral vascular disease work up and possible peripheral intervention. D.G.’s story is similar to stories of many residents in the East Harlem community. Statistics show that incidence of residents within the East Harlem community who have chronic illnesses such as heart disease, diabetes and lung disease are significantly higher than average compared to 41 other New York City communities. The NYC Department of Health also reports that cardiac disease is the leading cause of adult hospitalizations in East Harlem (2003). North General Hospital is a community hospital with 200 patient beds. Many East Harlem residents utilize the facility for their health-care needs. In order to forge an attack on the prevalence of cardiac disease in this community, North General Hospital, in conjunction with Mount Sinai Medical Center, upgraded the available cardiology services to include a diagnostic cardiac catheterization laboratory. The collaborative effort to build a state-of-the-art cardiac catheterization laboratory at NGH in order to provide integrated cardiovascular screenings and diagnosis has been beneficial to the East Harlem community. The high incidence of cardiac disease in this area is due to risk factors not limited to obesity and diabetes. Other risk factors, including stress, sedentary lifestyle, hypercholesterolemia, smoking and hypertension all play a major role in the development of coronary artery disease and increased mortality. According to the New York City Department of Health, mortality rates associated with heart disease, stroke and diabetes in the East Harlem community is 45% higher than that of NYC as a whole. The hope of bringing a diagnostic cardiac catheterization laboratory to NGH is to decrease the health care disparities among East Harlem’s underserved population (2003). The knowledge, expertise and proficient clinical care imparted by the cardiac catheterization staff provides education and other appropriate interventions geared towards reducing risks associated with cardiac disease. This unique collaboration between Mount Sinai Medical Center and North General Hospital enables clients within the community hospital setting to have access to a higher level of cardiac care. Interventional cardiologists who perform the diagnostic procedure at NGH also perform the coronary intervention procedure at Mount Sinai Medical Center once the diagnosis is made and the patient is transferred to Mount Sinai. Therefore, the continuity of care is maintained. In turn, the nursing staff also from Mount Sinai embraces the responsibility within this community hospital setting to initiate evidenced-based practice in order to decrease cardiac risk factors. This is apparent by health promotion and disease prevention and management strategies implemented through assessment, counseling and education, which include dietary counseling, smoke cessation interventions, promoting healthy lifestyle changes and immunizations. Since our opening in December 2005, 14% of our total cases have been identified with significant coronary artery disease requiring coronary intervention. One hundred percent of our cases have been without complication. In addition, our patients have verbalized an increased understanding of coronary artery disease and have expressed appreciation of the educational efforts put forth by the nursing staff in the cardiac catheterization laboratory. Future objectives for the nursing staff of the Mount Sinai Cardiac Cath Lab at North General Hospital consist of community health screenings for hypertension and hypercholesterolemia, monthly community education sessions on cardiac disease risk factors and nursing grand rounds for the NGH nursing staff. The authors can be contacted at Tanya.Sullivan@msnyuhealth.org

1. NYC Community Health Profiles, NYC Department of Health and Mental Hygiene; Division of Epidemiology, Bureau of Epidemiology Services (2003).