Out-Patient Cardiology Centers. Sydnie Moix, MSN, APRN, FNP-C

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1 Out-Patient Cardiology Centers Sydnie Moix, MSN, APRN, FNP-C

2 Objectives Defining out-patient cardiology centers Benefits of outpatient cardiology centers Services provided (using AHH Conway Clinic as an example) Applying to practice

3 Defining Out-Patient Cardiology Centers Out-Patient Cardiology Centers offer basic cardiac care, as well as a variety of specialty services including advanced diagnostic procedures and interventions They are an integration of clinic and hospital Can be seen as a one-stop-shop for evaluation and treatment of different cardiac disease processes

4 Benefits of Out-Patient Cardiology Centers Ambulatory centers have quickly grown in popularity as a highquality, cost-effective alternative to hospital-based outpatient care Patients have easier and quicker access to personalized cardiac care in one location Multiple specialties and procedures are offered in the same clinic Same day testing is often available They help to free up space at the hospital for more acute/complex cases There is a stigma of having to go to hospital, so the more that can be done in an outpatient setting the more comfortable patients feel

5 Services Provided AHH Conway Clinic

6 Services Provided The Basics Annual Cardiac Exams and Evaluations X-rays Routine Lab/Stat-Lab ECG INR and Blood Glucose POCT

7 Services Provided Non-invasive Cardiac Testing Treadmill Stress Tests Stress Echo Nuclear Stress Tests Echocardiograms Bubble Study hour Holter Monitor 2-4 week Event Monitor Pacemaker/ICD device checks and programming Carotid Ultrasound AAA Screening

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9 Services Provided Invasive Cardiac Diagnostic Procedures and Interventions Selective coronary arteriogram (SCA) Graft Revisualization Right Heart Catheterization Aorto-femoral runoff angiography 4-Vessel Carotid Angiography Percutaneous Coronary Intervention Transesophageal Echocardiograms (TEE) Cardioversion CardioMEMS Implantation

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11 Services Provided Specialty Services Vein and Vascular Institute (ABIs, Vein Mapping, Ultrasound) Electrophysiology Device Clinic Diabetes Education Wound Clinic Hyperbarics Mini CHF Clinic**

12 HBOT Indications: Diabetic Foot Ulcers, Osteomyelitis, Soft Tissue Radiation Injury, Carbon Monoxide Poisoning, Air or Gas Embolism, Acute Limb Ischemia, Necrotizing Fasciitiis, Crush Injuries, Decompression Sickness, Brown Recluse Spider Bites, Compromised Skin Grafts and Flaps Wounds We Treat: -Diabetic Foot Ulcers -Pressure Ulcers -Arterial and Venous Insufficiency Ulcers -Complex Soft Tissue Wounds -Non-healing Surgical Wounds -Traumatic Wounds -Gangrene -Radiation Tissue Damage -Infected Wounds

13 Applying to Practice CASE STUDY #1 T.C. is a 68 year old gentleman who presented to our clinic with a Wagner grade 4 diabetic foot ulcer on his left heel (extended down to the bone) and osteomyelitis. He has a PMHx of PAD, venous insufficiency, T2DM with peripheral neuropathy, and HTN. During the 5 month course of his treatment he received: Localized wound care 6 weeks of IV antibiotics (home health) Diabetes educator counseling to control diabetes Evaluation by Vein and Vascular Institute Peripheral revascularization of femoral-popliteal artery of left leg 60 Hyperbaric Oxygen Treatments

14 Applying to Practice CASE STUDY #1 CONTINUED Most of these services were offered in our clinic, except for IV antibiotics and the revascularization of his left leg. All of the services were initiated by our clinicians and required the efforts of a multi-disciplinary team. After 5 months, the patient s foot ulcer was completely healed.

15 Applying to Practice CASE STUDY #2 J.R. is a 77 year old lady who presented to our clinic with complaints of heart fluttering and new onset fatigue and shortness of breath. An ECG showed that the patient was in atrial fibrillation with HR of 130bpm. She has a PMHx for HTN and CAD (2 stents in 2002). The following were performed: Lab work Echocardiogram Nuclear Stress test Transesophageal echocardiogram Cardioversion Medical Management- Anticoagulation (Eliquis) and Rate Control (Beta Blocker) Consult with Electrophysiology for anti-arrhythmics vs ablation

16 Applying to Practice CASE STUDY #2 CONTINUED Although the patient ultimately had to go to the hospital for treatment, all of her other testing, procedures, and work up were performed at our clinic in Conway.

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18 Arkansas Heart Hospital Clinic Locations

19 Contact Information Arkansas Heart Hospital Clinic 605 Dave Ward Drive #105 Conway, AR Office Phone: (501) Sydnie Moix, APRN: (501)

20 Resources American College of Cardiology. (2017). Revolution and evolution: emerging trends in cardiovascular medicine. Cardiology Magazine, revolution-and-evolution-emerging-trends-in-cardiovascular-medicine Resources American College of Cardiology. (2016). The increasingly compelling case for an ambulatory surgery center strategy in cardiovascular care. CardioSource World News, cardiology/articles/2016/01/06/14/36/business-consult-ambulatory-surgery-center-strategy Beekman, A. (2017). The ambulatory approach. Cardiac interventions Today, 11(3) Photography: Lauren Westwood

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