By collaborating with the National Institutes of Health, Doylestown Hospital evaluates innovative treatments for cardiovascular disease. Patients receive state-of-the-art care as physicians simultaneously advance medical science.

Is that physician striding down a Doylestown Hospital corridor on his way to see a patient? Begin a procedure? Conference with a family? Actually, he could be heading toward any of the three — and also conducting research at the same time.

Separate from but in close proximity to the emergency room and inpatient units is the Medical Research Department of Doylestown Hospital, the “operations center” from which the hospital helps to carry out groundbreaking studies. The investigative skills of our hospital medical staff members captured the attention of the National Institutes of Health (NIH), which recently selected Doylestown Hospital to participate in two influential cardiovascular and renovascular studies. While results and recommendations are years away, these trials are improving care for individual patients already. They’re also highlighting Doylestown Hospital’s role as not only a community resource, but a national and scientific resource as well.

To Bypass or to Stent, That is the Question
Doylestown Hospital cardiologist Joseph McGarvey, Jr., MD, directs the hospital’s participation in NIH’s nationwide FREEDOM study, an inquiry comparing two methods of treating multi-vessel coronary disease in people with diabetes. “Typically, care for diabetics with this condition is bypass surgery, but angioplasty and stenting is far less invasive, and we’d like to employ that if we can be assured of the same positive results,” says Dr. McGarvey. The FREEDOM study aims to find out which approach is more effective for a rapidly growing U.S. diabetic population that numbers 21million and experiences more cardiovascular disease than average Americans.

A member of the research team screens diabetic study candidates when they enter the hospital with symptoms like shortness of breath, stress test failure, or angina. Then, physicians in the cardiac cath lab perform a diagnostic catheterization to inspect the patient’s heart and coronary blood vessels. A small group of patients will qualify and may choose to take part in the study (after thorough briefings by research staff). They are randomly assigned to receive either bypass surgery or stenting.

Stent Technology Advances
Bypass surgery employs vessels taken from other areas of the body to redirect blood around clogged coronary arteries. Patients often receive multiple bypass grafts during one surgical procedure. Stenting is a newer treatment that opens blocked arteries from inside the vessel. Physicians thread instruments through a small incision in the groin, arm, or wrist vessels to first inflate a tiny balloon that compresses artery narrowing plaque near the heart; then they insert a tiny mesh tube or stent that props the vessel open. Early stents were bare metal and, unfortunately, led to new blockages about 25 percent of the time. Today’s innovative devices are sophisticated distant cousins of their predecessors. The newer stents release small, steady doses of medicine into artery walls and have reduced rates of new blockages to about five percent.

FREEDOM trial results could change the standard of care for diabetics with heart disease. If stenting proves as promising for this group as for others without diabetes, it may lower death rates, complications, and treatment costs. “Bypass patients spend five to seven days in the hospital and often months recovering,” Dr. McGarvey notes. “Stent recipients usually go home the next day and can be back to work in a week.” Those receiving stents also may avoid major risks associated with bypass surgery, such as infection, stroke, and neurological effects.

Attacking High Blood Pressure
Stents also feature prominently in NIH’s CORAL study, directed at Doylestown Hospital by Dr. McGarvey and nephrologist Melchiore Vernace, MD. This investigation will assess whether stents can help reduce complications such as hypertension caused by narrowed arteries supplying the kidneys. Also called renal artery stenosis, the condition highlights the complex chemical interactions that can take place in the human body. Fatty deposits coat the inside of vessels leading to the kidneys, reducing blood flow. To compensate, the kidneys release hormonal messages that raise blood pressure.

Medication has been the mainstay of treatment for this difficult condition, which afflicts between one and five percent of those with high blood pressure. It may be diagnosed when a patient’s hypertension is new, unexplained, occurs after age 65 for the first time, or doesn’t respond well to drug treatment. “The CORAL trial asks if stenting plus medication improves patient survival and long-term health versus medication alone,” explains Dr. Vernace. This trial does not specifically focus on individuals with diabetes, though patients with renal artery stenosis often have chronic health conditions.

Benefits Now, Data Later
Even before researchers tabulate results, such studies often benefit individuals immediately. “Studies have shown that people who participate in clinical trials get excellent care,” Dr. Vernace comments. “Patients often qualify for a host of peripheral benefits as well. CORAL participants, for instance, receive free medication that could be quite expensive otherwise.” Further, participants receive frequent exams, laboratory testing and close follow-up – including a 24-hour phone number for questions or problems – that can catch related and unrelated medical issues. In the process, study patients often form warm relationships with the research team,which can boost overall wellness.

If stenting proves effective against renal artery stenosis, the study could provide a new tool for the currently sparse stockpile against a stubborn type of hypertension. Data also may indicate that some with the condition benefit from stenting while others do not. Lowering high blood pressure reduces threats such as stroke, heart attack, and kidney damage, aiding a risk group that numbers 65 million in this country alone. One in three adults grapples with hypertension, and the condition kills more than 50,000 Americans annually.

Raising the Hospital’s Profile
“These trials are prestigious, and we’re proud that the NIH recognized the quality of our care, our research capabilities, and our medical team,” Dr. McGarvey says. Participation in such studies furthers medical science and delivers cutting-edge medical technology to our local area.

Additionally, the hospital’s influence reaches far beyond the immediate community, in essence improving the care of patients who have never walked through the institution’s doors. That’s an exhilarating experience for administrators and physicians who, like Drs. Vernace and McGarvey, entered medicine to improve our human lot, whether for one patient at a time or a whole population grappling with modern afflictions like heart disease and hypertension.

Dr. Joseph McGarvey, Jr. is with Central Bucks Specialists, Heart and Vascular. Dr. Melchiore Vernace is with Nephrology- Hypertension Specialists.