Cardiology Fellowships: Urban Community Program

Program Design: Elmhurst Hospital Center

Elmhurst Hospital Center is a 513-bed hospital with services spanning the entire age range and including 29 residency programs as well as a Level I Trauma Center. It serves an area of approximately one million people from among what may be the most ethnically mixed community in the world: There have been 20,000 recent immigrants from 112 countries. The patient population is primarily from South and Central America, the Caribbean, Asia, Africa and Eastern Europe. Many of these patients have important cardiac conditions not often seen in the US (rheumatic heart disease in young and middle age adults; previously undiagnosed congenital heart disease; tuberculous pericardial disease) as well as more common ailments (premature coronary artery disease).

Elmhurst Hospital Center and The Icahn School of Medicine have a strong relationship involving medical students, house staff and faculty that is three decades old.

CCU and Telemetry

The CCU is a modern, fully equipped 9-bed unit, adjacent to an 8-bed respiratory ICU (which accommodates occasional overflow patients). Temporary pacemakers, arterial lines, right heart catheters and intraaortic balloon pump support are all available. The fellow makes rounds daily with an attending cardiologist and two PGY-2 medicine residents and, often, one Mount Sinai emergency medicine resident. The demographics of the neighborhood surrounding Elmhurst Hospital Center coupled with its busy emergency room (over 120,000 visits last year) dictate a CCU predominantly filled with patients with acute coronary syndromes. A 22-bed telemetry unit (under Medicine) provides an intermediate level of inpatient care. (The fellow on the Consults rotation makes rounds on the telemetry patients with an attending cardiologist.) Patients requiring additional resources or support are transferred to Mount Sinai.

Cardiac Catheterization Laboratory

The modern digital catheterization laboratory (identical to that at Mount Sinai) is staffed by an attending cardiologist and a cardiology fellow. Together, they make rounds on pre- and post- catheterization patients, perform catheterization procedures, review angiograms and make recommendations for management. Over 1,000 catheterizations were performed last year. On a weekly basis, catheterizations are reviewed with an interventional cardiologist and cardiothoracic surgeon from Mount Sinai Hospital (see Conferences section). A study of primary angioplasty in acute myocardial infarction in hospitals without bypass surgery (C-PORT) is underway. A second, identical catheterization laboratory will be opening later in the year.

Echocardiography Laboratory

A full-time echocardiography attending and four technologists utilize four modern echocardiographs to perform a variety of studies: transthoracic (rest, exercise, pharmacologic) and transesophageal. Studies are performed and read daily with the fellows. A wide variety of cardiac pathology is seen, including valvular disease (rheumatic and non-rheumatic), ischemic disease, cardiomyopathies and congenital heart disease. A digital imaging and computerized reporting system are used.

Nuclear Cardiology and Stress Laboratory

Two treadmills and four nuclear cameras constitute the equipment in this laboratory. Studies (rest, exercise, pharmacologic) are reviewed with an attending cardiologist and a nuclear medicine physician. A broad spectrum of ischemic and non-ischemic syndromes comprise the varied patient population.

Cardiology Clinic

The Cardiology Clinic at Elmhurst operates in a newly renovated and very attractive facility. Yearly, over 4,000 patients are seen in the course of four afternoon sessions each week. Specialized programs directed at the evaluation and management of hypertension, hyperlipidemia, congestive heart failure, and cardiac rhythm disturbances are present. The cadre of clerical staff, social workers, dieticians and nurses to complete the patient care team are joined by a “language bank” which readily supplies interpretative support for the many languages spoken by these diverse patients. Fellows are assigned to one session weekly for the entire three years of training. Those fellows on rotations at Mount Sinai Hospital and Cabrini Medical Center will attend this clinic.

Primary responsibility for all aspects of cardiovascular care of these patients is vested in the fellows. This includes referral for noninvasive and invasive diagnostic testing and interpretation of results, prescription of medications, and communication with the referring physician within and outside of the Elmhurst Hospital Center. Fellows maintain continuity of care by seeing the same patients in follow-up visits and during hospitalizations throughout the three-year program. New patients are preferentially assigned to first year fellows so that continuity is maintained for as long as possible. When a fellow graduates from the program, the assignment of patients of the departing fellow to a first or second year fellow is done by the local program director, Dr. Rubinstein, on an individualized basis to best match the interests, educational opportunities and workloads of the fellows. In addition, one fellow attends a biweekly pacemaker clinic (Wednesday afternoons) with Dr. Bharucha.