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The basics:

• New Jersey hospitals are driving cardiac care advances
• Innovations include ECMO, pulsed field ablation and robotic surgery
• AI, remote monitoring and advanced imaging improve survival rates
• Hospitals balance lifesaving innovation with cost and reimbursement hurdles

When a woman was brought to a RWJBarnabas hospital’s emergency room after collapsing at home, “She was diagnosed with acute heart failure and found to be in cardiogenic shock,” said Dr. Conor Barrett, RWJBarnabas Health senior vice president and chief clinical officer for heart and vascular services.

“Her care team immediately activated the Cardiogenic Shock Team, and she was transferred to Robert Wood Johnson University Hospital, where she received life-saving support via VA ECMO [a heart-lung bypass machine], followed by transitioning to a temporary artificial heart pump until her heart demonstrated signs of recovery. Because of our integrated Heart & Vascular services with advanced connections – and transfer from one of our hospitals to a facility with more advanced technologies – she received expert care in the most timely way possible. She fully recovered and resumed her active life when she was discharged home to her loving family.”

Heart disease remains the leading cause of death for men and women in New Jersey, noted Barrett. “At RWJBarnabas Health, we have New Jersey’s most comprehensive academic network of care, through the continuum from the out-patient setting to our cardiac diagnostic, imaging, and therapeutic technology offerings,” he said. “We have been very much focused on improving access for patients who need our care, ensuring that we continuously innovate and bring new technologies to our patients while simultaneously ensuring that we keep a keen focus on the quality of care we deliver.”

To balance innovation with access and affordability, “we made it a point to invest in technologies that improve patient-experience and outcomes, therefore both improving quality and reducing overall cost,” Barrett detailed. “This is achieved through various investments, including the state’s largest heart-valve program, remote patient-monitoring and our electronic medical record system which enhances care coordination and patient scheduling, reduces hospital readmissions, and implements critical safety measures.”

In fact, cardiac care has produced remarkable advancements in recent years. Hospitals and health care institutions across New Jersey are at the forefront of this transformation, leveraging state-of-the-art tools and techniques to provide safer, more effective, and less invasive cardiac care. NJBIZ spoke with some leading experts to explore how these innovations are shaping the future of heart health and improving the quality of life for patients.

On the cutting edge

A longtime South Jersey police officer with a history of high blood pressure was headed toward heart failure, but an innovative treatment significantly improved the officer’s health while eliminating many of his medications, according to Dr. Chun (Dan) Choi, Virtua Health vice president of clinical operations for the cardiovascular service line.

“After studying the patient, we concluded that renal denervation would be the best option,” Choi explained. “In this minimally invasive procedure, a cardiologist uses a catheter to send ultrasound or radiofrequency (heat) energy to the blood vessels in an area around the kidney that are involved in blood pressure regulation in an attempt to destroy those nerve cells without damaging the arteries. This results in reduced nerve activity, which subsequently causes a drop in blood pressure.”

Other cutting-edge cardiac treatments include tiny, drug-coated “balloons” that are used to treat coronary artery disease. “These micro balloons are expanded within the coronary vessels that already had a stent placed before, delivering medication directly to the inner lining and preventing restenosis, or a reoccurrence of blood vessel narrowing,” he said.

Along with saving more lives, these and other minimally invasive treatments are often less expensive than previous treatments, an important factor as medical reimbursement rates continue to fall.

“Unfortunately, the payment structure hasn’t quite caught up yet, so health care institutions are still getting squeezed financially,” warned Choi. “But earlier this year the federal CMS [Centers for Medicare & Medicaid Services] approved some initial fee-structure changes, and we believe that commercial payers will follow suit next year.”

Another exciting development in cardiac care is “pulsed field ablation a treatment option for atrial fibrillation,” noted Dr. Suneet Mittal, chair of the cardiovascular service line for Valley Health System. PFA utilizes short, high-voltage electrical pulses to destroy targeted heart tissue.

“Traditionally, we used heat or freezing techniques, but these posed a risk of collateral tissue damage,” he added. “Pulse field ablation, on the other hand, offers more precision and significantly reduces the risk of damage to surrounding tissues. This innovative approach not only enhances the safety of the procedure but also ensures faster recovery times for patients.”

Valley Health System has “observed very high success rates with pulse field ablation, significantly reduced procedural times, and decreased length of stay as many patients are able to leave the hospital the same day,” Mittal detailed. “This not only can improve the quality of life for patients but also reduce the financial burden on health care facilities.”

Other significant advances include artificial intelligence, which aids in diagnostics and personalized treatment plans, he noted. “The impact of these technologies on patient outcomes has been profound,” said Mittal.

Rapid response

Critical seconds counted when a man in his 60s arrived at Englewood Hospital with severe heart failure, according to Dr. Joseph De Gregorio, executive director of cardiovascular services at the regional facility. Physicians were trying to open a blocked, heavily calcified artery and, “The patient became hemodynamically unstable [blood flow in his body was inadequate to meet the needs of his tissues], and he was unable to tolerate the procedure,” said De Gregorio. “We needed to stabilize his blood pressure and cardiac function before proceeding.”

To accomplish this, “an Impella heart pump was inserted into the left ventricle, allowing us to safely perform the coronary intervention,” he explained. “We utilized a Rotablator drill and intravascular lithotripsy [shockwave balloon], followed by successful stenting of the artery. He improved almost immediately. In the past, a patient in his condition might have had no viable treatment options and a far more dire outcome. It was a remarkable turnaround thanks to the latest technology and the experience of our team.”

At Englewood Hospital, “We’re using the latest tools to care for cardiac patients across subspecialities in less invasive and more effective ways,” De Gregorio added. “In congestive heart failure, innovations include the CardioMEMS device, which allows us to remotely monitor patients at home to prevent episodes of heart failure.”

These and other advances mean improved treatment for more patients, but “new cardiac technologies often come with significant upfront costs, particularly before they are eligible for reimbursement,” cautioned De Gregorio. “At Englewood, we carefully evaluate each new innovation through a structured review process that considers both clinical impact and financial sustainability. We work closely with insurers, sharing data and results to advocate for better reimbursement and support long-term value-based care.”

A robotic assist

When Bergen New Bridge Medical Center introduced the da Vinci 5 robotic surgical system less than a year ago, it became one of the few hospitals in New Jersey to offer this state-of-the-art platform, according to Dr. Irfan Admani, chief of cardiology at the health care institution. “Surgeons use it to perform complex procedures with more precision through tiny incisions, resulting in less pain, fewer complications, shorter hospital stays, and faster recovery for patients,” he explained. “While primarily used in areas like urology and general surgery initially, its precision capabilities may support advanced cardiac-associated procedures or minimally invasive interventions in the near future.”

Additional advances – like robotic surgery and other forms of minimally invasive surgery – can reduce trauma, infection risk and recovery time, he added. “This translates into better patient care and higher patient satisfaction. The number of complications and length of stay in the hospital will be reduced as well for most patients.”

But robotic surgical systems, coronary CT [computed tomography, a medical imaging technique] angiography, and advanced cardiac imaging tools require significant financial investment, Admani noted. “Costs include the purchase of equipment, staff training, upgrades to IT as well as overall infrastructure, and continued maintenance and software updates.”

At the same time, insurance companies and government payers, including Medicare and Medicaid, are often slow to raise reimbursement rates, and in some cases, those payments are being reduced, he cautioned. “This creates a gap between what it costs to provide high-tech care and what the hospital gets paid.”

But even as they wrangle with rate-setters, medical professionals at New Jersey-based hospitals continue to save lives. A 53-year-old man who recently went to a Hunterdon Health primary care physician for elevated cholesterol management was recommended to undergo a cardiac calcium score test that likely saved his life, according to Dr. Rupen Parikh, a cardiologist who leads Hunterdon Health‘s Cardiac Rehab.

Tests designed to measure the amount of calcium buildup in coronary arteries led to a referral to a Hunterdon Health cardiologist and, after multiple blockages were discovered, he underwent coronary bypass surgery.

“The patient is now doing extremely well,” according to Parikh, who highlighted several new cardiac advances that will further increase survival rates. “One of the most significant is the use of bloodwork to measure lipoprotein (a) levels, especially for individuals with a family history of cardiovascular disease or death. This test helps identify high-risk populations early, allowing for timely intervention.”

An ounce of prevention

Along with tech advances, preventative care is a vital component of cardiovascular care, according to Dr. Steven Sheris, executive vice president, chief physician executive, Atlantic Health. He emphasized the importance of managing lipid levels, diabetes and blood pressure to reduce the risk of major cardiac events.

“The challenge is patient engagement,” he warned. “Conditions like diabetes and high cholesterol require ongoing attention and a strong doctor-patient relationship. It’s about getting patients to establish and maintain their health goals.”

Advances like the development of minimally invasive procedures are making a big difference, Sheris added. “Techniques such as transcatheter aortic valve replacement (TAVR) have revolutionized the treatment of heart valve diseases,” he explained. “These procedures reduce recovery times and lower the risk of complications compared to traditional open-heart surgery. Atlantic Health is a leading center for TAVR, and their use of this technology in less symptomatic patients allows for earlier intervention and better outcomes.