Las Vegas Cardiology Clinic leads out on heart failure management

When we use the term “heart failure management”, we’re talking about more than just “the heart."  We’re talking about pulmonology, the vascular system, blood pressure, rhythms, nutrition, and behavior. Our cardiovascular system is complex, and there are many factors to heart health upkeep, from the physical to a patient’s social environment. 

It takes a group of dedicated caregivers like Intermountain Health's cardiology team at the La Canada Cardiology Clinic in Las Vegas to simplify this complexity for our patients as much as possible.  This site (which, because of its centralized location in Las Vegas, serves as a specialty hub) is leading out on multiple advanced heart failure management procedures to help our patients stay out of the hospital, promoting not only good heart health, but effective intervention techniques. From cardiologists like Corey Lum, DO, to the nurses and medical assistants, every caregiver plays an important role.

Diuresis 

Diuresis is the process of removing excess fluid from a person who has too much in their body, which is causing swelling and backups, including in their heart. La Canada has a room dedicated to IV diuresis, which was first introduced in November 2023. Alicia Fox, cardiology RN, said the outcomes have been positive. “I think everyone has gotten behind it at this point,” she said. “We've had 44 patients come through, and eight of them have gone back into the hospital within 30 days. But some of those were not specifically for heart failure admissions. It's shown that it's worked, that patients are happy. We're getting less SMT calls.”  

Alicia leads out on the diuresis work but has put systems in place to allow other clinic nurses to perform the same quality work if she’s out of the office. She’s only been with Intermountain for a year but already her work and leadership with heart failure management has been recognized via a DAISY Award and a UNLV Nurse Trailblazer Award. 

But for Alicia, success is regularly checking on their patients and seeing they don’t have any new symptoms and feel better about themselves. “Everyone tries to make a difference and do the best for the patient. That's why we're doing this,” she said. “When I'm interacting with people, I want to think about what the education moment is. What is their level of understanding of this topic, and can I help so the patient can better care for themselves at home? For me, I'm always trying to educate at the same time.” 

CardioMEMS 

CardioMEMS is a process the La Canada team also utilizes.  A small chip is inserted into a patient’s pulmonary artery, and it measures daily artery pressure.  Through a remote monitoring system, our caregivers can identify potential symptoms of worsening heart failure within 30 days and intervene sooner. “When we see those abrupt pressure changes, that is our cue to adjust medical therapy before they're symptomatic, before they are short of breath, are up five to 10 pounds in weight or before they have leg swelling,” said Carrie Lofton, nurse practitioner. “With that, we've been very successful in reducing hospitalizations.” Alicia added, “For the patients that we have, after the device is implanted, they haven't had heart failure readmission.” 

Story Health

Story Health for Heart Failure, like CardioMEMS, uses remote monitoring to track a patient’s progress.  It’s currently a pilot program in Utah with plans to expand in Nevada. Through a team approach involving the provider, health coaches, and the patient, the program tracks a patient’s cardiac medication and sets goals to update the dose, if necessary, with regular check-ins. The clinical team will contact the patient when a change is made and follow up to make sure they’re doing well. “What it does is it reduces our time in clinic,” Carrie said. “We don't have to see these patients as often, and it helps our ancillary staff, like our nurses, our medical assistants, because they don't have to call the patients frequently, either.” Nevada was a test site for the Story Health pilot through Intermountain Ventures. It was highly successful in patients reaching their target therapy sooner; reducing travel times for patients to clinics; and freeing up providers in clinics.  As a result, this program is now in the early phases of expansion. 

Intertwined within all these processes is a commitment to educating patients so they can adhere to healthy habits at home to help reduce readmissions.  

That education can come down to questions about their daily routines, like medications taken, food and drink consumed, and physical activity.  But it can also reveal personal obstacles, like not being able to pay for medication or better food options. “Every chance you meet with a patient, you have to understand what their barriers are and try to help work through that,” Carrie said. “Some of these patients need a case management referral to help with some of their social needs, which then helps them take better care of their condition. You need to get down to the patient level and understand what they’re willing to change and accept and certain things that they won't.” 

A Fresh Perspective on Quality Care

Yasmine Esquivel, nurse navigator, joined Intermountain in February 2024 after spending most of her career in the hospital setting, specifically the Intensive Care Unit. She and Alicia work in tandem at La Canada in treating patients. “I wanted to be in a role where I could focus on education and prevention, and this role’s exactly that.” 

In a short time at Intermountain, Yasmine’s seen how much heart failure management and intervention can make a difference, especially on the education side. “It's so rewarding to see it click and [patients] get it over time,” she said. “I think it's empowering for them to put our teachings into real-life practice, and it works for them.”  Yasmine added while it can be stressful for patients dealing with medical and social challenges, she knows the team at Intermountain is helping them try to come out on top.

“If somebody needs something, I want to be there,” she said. “It's always important, but it's so much more powerful when it's in terms of helping somebody take control of their health and their life.”