Q: What is your role and the role of National Cardiovascular Partners?
BC: National Cardiovascular Partners (NCP) is an outpatient catheterization lab business, also called a cath lab. We take care of patients who have cardiac disease whether they need a heart catheterization, pacemaker, defibrillator, coronary stent or any type of cardiac disease that can be taken care of in an outpatient setting. We are also very active in treating patients with peripheral arterial disease such as obstructed arteries in the arms and legs and occasionally patients with diseased renal arteries.
I work really closely with our chief clinical office and chief operating officer to be on top of all the clinical and medical aspects of what is going on at NCP, such as the peer review process or clinical changes that need to be made for patient care. I also act as a liaison between the doctors and administrative side to assist in any problem that may arise.
Q: How do you work within the larger company of Fresenius Medical Care North America, which is more widely known for treating kidney failure rather than cardiac disease?
BC: Patients usually have heart disease because of risk factors like high blood pressure, high cholesterol and diabetes, which are the same risk factors for kidney disease. So there are going to be a lot of renal patients with cardiac disease and a lot of cardiac patients with renal disease. It makes sense that we work closely together.
In addition, people with end stage renal disease, or ESRD, are required to have vascular access, and so a lot of what we do at our cath labs in treating vascular disease can be helpful for the nephrologists and their patients. Many renal patients also have other cardiac issues like arrhythmias, valvular heart disease or myocardial disease (disease of the heart muscle) as a side effect of their ESRD. There is overlap in our patients early on from similar risk factors and later on because of the progression of the disease and the way it affects the heart.
Even in the pre-dialysis ESRD patients, it makes sense for us to work together as a team because those patients have a lot of vascular disease and they require treatment from us. As a team, we can better manage the patient with the nephrologist and cardiologist working together.
Q: Are you seeing an increase in this cardiorenal approach with cardiologists and nephrologists working more as team?
BC: This whole concept of cardiorenal healthcare makes great sense, and I think that is something that has been improving over the years. We will continue to see more of a collaboration between those two specialties. In our labs, we are increasingly seeing both nephrologists and cardiologists doing procedures, and that allows for good communication and cross training.
If you take a small moment in time for a dialysis patient, when they start dialysis, there is increased risk of cardiac events because of change in volume and electrolyte shifts. Even changes of profusion of the heart muscle during dialysis can put patients at risk from a cardiac standpoint. When ESRD patients have been on dialysis for a long time they can also have problems with calcium metabolism which can equate to progression of coronary heart disease.
We have a lot to learn from each other and together we can continue to push for more research and education related to cardiac disease in renal patients.
Q: What is an area for improvement as we work to better treat the whole patient?
BC: As we move away from volume of patients seen toward more value based care models, there has to be better communication between specialists and between primary care doctors. As our company works to get all these practices that overlap in patient care to work better together, it will provide us more opportunities to care for patients in a more holistic way.
Q: What are you most excited about for improving care of people living with heart disease that people should know about?
BC: If you asked me five years ago, I would have said I am excited about all this new technology and all these great things that we can provide for our patients that are going be less risky, less invasive and improve quality of life.
All of that is really important to me, but we also need to think broader. We need to get together and look at outcomes, look at all the data for our patients together, and use that data to find new ways to prevent end stage renal disease and coronary disease. The harnessing of that data is what is really going to create better outcomes longterm.
Donald S. (Buck) Cross, M.D, is National Medical Director for National Cardiovascular Partners, and represents NCP on the Fresenius Medical Care Advisory Board. Dr. Cross is board certified in Cardiovascular Disease and has practiced as an Interventional Cardiologist with Waco Cardiology Associates for the past 15 years. Dr. Cross is a graduate of St. Edwards University and The University of Texas Medical Branch at Galveston.