Sanford Heart Hospital Project Summary: •Total Estimated Square Feet 205,000 •Physician Offices 23 •Cardiac, Thoracic, and Vascular Surgery •Sanford Cardiovascular Institute •Inpatient Beds Potential for 58 •Critical Care Unit •Cardiology •Operating Rooms Potential for 5 •Cath Labs Potential for 9 including a Hybrid Cath and dedicated EP Cath Lab •Outpatient Diagnostic TestingNuclear Medicine, Echo, Stress, Imaging •Project Completion Early 2012 Comparison of Coronary Calcium Score and Framingham Score in Determination of Cardiovascular Risk and Disease in Native American vs. General Population. Muhammad Khan, MD Tom P. Stys, MD, FSCAI, FACC Medical Director, Sanford Heart Hospital Sanford Cardiovascular Institute
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Sanford Heart Hospital
Project Summary:
•Total Estimated Square Feet 205,000
•Physician Offices 23•Cardiac, Thoracic, and Vascular Surgery•Sanford Cardiovascular Institute
•Inpatient Beds Potential for 58•Critical Care Unit•Cardiology
•Operating Rooms Potential for 5
•Cath Labs Potential for 9 including a Hybrid Cath and dedicated EP Cath Lab
• 81 million have 1 or more type of CVD †• CVD # 1 cause of mortality for the last 100 yrs • Cost of CVD and stroke in 2009 $470 billion †• At 50 yrs lifetime risk of
– CVD 50% ‡– breast cancer at 50 yrs 10%
† Lloyd-Jones, D., R. Adams, et al. (2009). "Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee." Circulation 119(3): e21-181.
‡ Lloyd-Jones, D. M., E. P. Leip, et al. (2006). "Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age.“ Circulation 113(6): 791-798.
http://seer.cancer.gov
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Sanford Heart HospitalProject Summary:
•Total Estimated Square Feet 205,000
•Physician Offices 23•Cardiac, Thoracic, and Vascular Surgery•Sanford Cardiovascular Institute
•Inpatient Beds Potential for 58•Critical Care Unit•Cardiology
•Operating Rooms Potential for 5
•Cath Labs Potential for 9 including a Hybrid Cath and dedicated EP Cath Lab
• Rate of decline of CVD mortality is slowing down †
• 50% of adults suffer acute MI each year without prior symptoms ‡
• For 25% of people the first sign of underlying CVD is sudden cardiac
death ‡
† Cooper, R., J. Cutler, et al. (2000). "Trends and disparities in coronary heart disease, stroke, and other cardiovascular diseases in the United States: findings of the national conference on cardiovascular disease prevention." Circulation 102(25): 3137-3147.
‡ Myerburg, R. J., K. M. Kessler, et al. (1993). "Sudden cardiac death: epidemiology, transient risk, and intervention assessment." Ann Intern Med 119(12): 1187-1197.
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Sanford Heart HospitalProject Summary:
•Total Estimated Square Feet 205,000
•Physician Offices 23•Cardiac, Thoracic, and Vascular Surgery•Sanford Cardiovascular Institute
•Inpatient Beds Potential for 58•Critical Care Unit•Cardiology
•Operating Rooms Potential for 5
•Cath Labs Potential for 9 including a Hybrid Cath and dedicated EP Cath Lab
‡• Calcium score has incremental value over traditional risk factors ‡• Adding calcium score to traditional risk factors can change
recommended therapy *
† Sangiorgi, G., J. A. Rumberger, et al. (1998). "Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque
burden in humans: a histologic study of 723 coronary artery segments using nondecalcifying methodology." J Am Coll Cardiol 31(1): 126 133.
‡ Detrano, R., A. D. Guerci, et al. (2008). "Coronary calcium as a predictor of coronary events in four racial or ethnic groups." N Engl J Med 358(13):1336-1345.
* Polonsky, T. S., R. L. McClelland, et al. (2010). "Coronary artery calcium score and risk classification for coronary heart disease prediction." JAMA 303(16): 1610-1616.
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Sanford Heart HospitalProject Summary:
•Total Estimated Square Feet 205,000
•Physician Offices 23•Cardiac, Thoracic, and Vascular Surgery•Sanford Cardiovascular Institute
•Inpatient Beds Potential for 58•Critical Care Unit•Cardiology
•Operating Rooms Potential for 5
•Cath Labs Potential for 9 including a Hybrid Cath and dedicated EP Cath Lab
Coronary artery calcification provides additional risk stratification beyond the Framingham risk estimate, especially in individuals with high calcium scores. A zero score does not exclude the risk of an event.
Greenland, P., L. LaBree, et al. (2004). "Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals." JAMA 291(2): 210-215.
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Sanford Heart HospitalProject Summary:
•Total Estimated Square Feet 205,000
•Physician Offices 23•Cardiac, Thoracic, and Vascular Surgery•Sanford Cardiovascular Institute
•Inpatient Beds Potential for 58•Critical Care Unit•Cardiology
•Operating Rooms Potential for 5
•Cath Labs Potential for 9 including a Hybrid Cath and dedicated EP Cath Lab
• Higher cardiovascular risk patient population• 8% of all Native Americans reside in SD †
• Incidence of CVD on the rise among Native Americans Ε SD/ND has the highest rate of non fatal MI * • SD/ND has twice as high CVD mortality as general US population *
† www.census.govÎ Howard, B. V., E. T. Lee, et al. (1999). "Rising tide of cardiovascular disease in American Indians. The Strong Heart Study." Circulation 99(18): 2389-2395* Lee, E. T., L. D. Cowan, et al. (1998). "All-cause mortality and cardiovascular disease mortality in three American Indian populations aged 45-
74 years, 1984-1988. The Strong Heart Study." Am J Epidemiol 147(11): 995-1008
Purpose: Comparison of Coronary Calcium Score and Framingham Score in Determination of Cardiovascular
Risk and Disease in Native American vs General Population.
Compare the value of coronary calcium score in detection of higher cardiovascular risk profile in a higher cardiovascular risk patient population (Native Americans) vs general patient population.
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Sanford Heart HospitalProject Summary:
•Total Estimated Square Feet 205,000
•Physician Offices 23•Cardiac, Thoracic, and Vascular Surgery•Sanford Cardiovascular Institute
•Inpatient Beds Potential for 58•Critical Care Unit•Cardiology
•Operating Rooms Potential for 5
•Cath Labs Potential for 9 including a Hybrid Cath and dedicated EP Cath Lab
• Program initiated February 2008• The Heart Screen is available for any person between the ages of 40-70
years old• Personal and Family History by Self Report• Height, Weight, BMI• Non-Fasting Cholesterol, HDL• Blood Pressure and EKG• CT Coronary Calcium Score• Physician Review of all test results• Case Manager follow-up with participant
* Data is recorded in Sanford Prevention Program Database.
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Sanford Heart HospitalProject Summary:
•Total Estimated Square Feet 205,000
•Physician Offices 23•Cardiac, Thoracic, and Vascular Surgery•Sanford Cardiovascular Institute
•Inpatient Beds Potential for 58•Critical Care Unit•Cardiology
•Operating Rooms Potential for 5
•Cath Labs Potential for 9 including a Hybrid Cath and dedicated EP Cath Lab
• Coronary Calcium Score is superior to Framingham Score in identification of patients with higher cardiovascular risk profile.
• Early identification of patients with higher cardiovascular risk profile through Cardiovascular Prevention Programs allows earlier initiation of aggressive preventive cardiovascular care measures.
• Coronary Calcium Score should be considered a valuable tool (superior to traditional approaches) in early detection of higher risk cardiovascular patients allowing appropriate early initiation of cardiovascular disease management and preventive care.
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Sanford Heart HospitalProject Summary:
•Total Estimated Square Feet 205,000
•Physician Offices 23•Cardiac, Thoracic, and Vascular Surgery•Sanford Cardiovascular Institute
•Inpatient Beds Potential for 58•Critical Care Unit•Cardiology
•Operating Rooms Potential for 5
•Cath Labs Potential for 9 including a Hybrid Cath and dedicated EP Cath Lab