Native American Cardiology Program at UMC

The Indian Health Services Center of Excellence in Cardiology is a collaborative approach to specialty patient care in cardiology at University Medical Center, Indian Health Services and The University of Arizona College of Medicine.

The Native American Cardiology Program (NACP) was established in 1994, in recognition of the changing health problems and needs of Native Americans in the Southwest. Prior to the 1960s, coronary artery disease was relatively uncommon among Native Americans. Over the past decades, changes in diet, economics and lifestyle have resulted in marked increases in the rates of obesity, diabetes, high blood pressure and kidney failure, all of which increase rates of coronary disease, heart attacks and cardiac deaths.

Diabetes 

Rates of diabetes and the metabolic syndrome are twice as high among Native Americans compared to the general US population. The most common cause of death for people with diabetes is cardiovascular disease. Unfortunately, these changes in risk factors have resulted in Native American death rates from heart disease that surpass those of the general U.S. population. Cardiovascular disease is the number one cause of death for Native Americans in the Southwest and around the nation.

Rheumatic Heart Disease

Rheumatic heart disease is another unique problem that affects Native Americans much more commonly than the general US population. High rates of rheumatic fever have resulted in a significant amount of valvular heart disease that has become rare among other populations in the country. The valve disease associated with this childhood illness may present 20 to 40 years after the episode of rheumatic fever and only half of the patients with rheumatic disease remember ever having had rheumatic fever. As a consequence, the NACP staff see high rates of mitral stenosis, often accompanied by other valve disorders that require surgical intervention. Staff diagnose and manage these difficult cases and work closely with cardiac surgeons at UMC when surgical intervention is required.

Cultural Understanding

The Native American Cardiology Program staff understands the unique living conditions and economic limitations that many patients face and incorporate these factors into decisions regarding valve surgery and anticoagulation needs. The circumstances and history of each patient are considered individually in making recommendations regarding surgical or percutaneous interventions.

Remote Clinics

The program is committed to delivering the best possible cardiac care to Native Americans in the Southwest. Continuity of care is essential and staff regularly perform cardiology clinics at Indian Health Service facilities throughout the Southwest. Native American Cardiology has facilitated an extensive program of distance echocardiography to enhance availability of services to more rural sites. Training is available through NACP for primary care providers interested in expanding their skills.

Pacemaker and ICD interrogation is regularly performed by physicians at several remote clinics. Also, many providers have been trained in exercise stress testing to increase availability of this vital skill. NACP maintains a vital registry of patients with pacemakers and defibrillators to ensure proper and
regular follow-up. The program, in conjunction with NACP consulting electrophysiologists, has placed remote monitoring devices for these patients at the various clinics to facilitate evaluation without distant travel.

Telemedicine

Telemedicine is a powerful means to assist in care delivery to rural populations. The Native American Cardiology Program, in conjunction with both the Indian Health Service Telemedicine Program and the Arizona Telemedicine Program, has been at the forefront of telemedicine outreach. The goal of these efforts is to expand and intensify delivery of cardiac care to more distant and rural Indian Health Service sites. Telemedicine at UMC allows staff to provide expanded care and interaction to distant areas. Current examples include

• interpret ECGs and electrocardiograms
• perform real-time stress ecocardiography
• interpret Holter monitoring at several IHS facilities

Tele-consultation clinics with NACP cardiology staff help to facilitate care delivery, provide triage for inpatient and outpatient questions and fill the need for specialist input through "telepresence." The cardiologists have provided continuing medical education lectures for healthcare providers. A clinical nutritionist is also available to provide tele-consultation and advice for patients using this technology.

Community Education and Outreach

Staff participate regularly in community education programs and outreach. NACP staff lectures at educational programs, both locally and nationally, to improve the understanding and treatment of cardiovascular disease and its impact on the health of Native Americans. Through leadership in state organizations, staff are working to eliminate healthcare disparities and improve the health and care of Native Americans and other minority populations.

University Medical Center Expertise

UMC, which is consistently ranked one of the best hospitals for cardiac care and cardiovascular surgery by U.S. News and World Report, provides the foundation for the NACP program. UMC has advanced technology, full consultative specialty services and excellent nursing staff.

Many Native American patients undergoing cardiac surgery are higher risk due to multiple medical problems. The cardiac surgeons at UMC provide excellent care and have a long, proven track record with excellent outcomes in these patients. UMC, as a tertiary care center, allows NACP staff to offer patients the full range of possible medical and surgical options for the management of their heart disease. The excellent nursing staff, 1:4 nurse to patient ratios, tremendous intensive care support services, outstanding cardiac rehabilitation and nutrition programs ensure our patients the best possible care and education while hospitalized.

Native patients often have multiple concurrent medical problems at the time of presentation with cardiac issues. As a result of high rates of diabetes, NACP sees high rates of kidney failure, peripheral vascular disease and cerebrovascular disease that may or may not be previously diagnosed. The availability of medical and surgical consultation, including vascular surgery and nephrology, is essential for the care of Native American patients.

For more information, contact the Native American Cardiology Program at (520) 694-7000 or toll-free (800) 524-5928.