Crouse Medical Practice Cardiology Central New York’s Premier Cardiac Care Team

By Thomas Crocker
Monday, March 4, 2019
Specialty: 

Backed by the advanced capabilities of one of the region’s leading cardiac care destinations, and with a nearly 40-year reputation for providing outstanding, patient-centered care, Crouse Medical Practice Cardiology is transforming heart care in Central New York.


Crouse Cardiology (l-r) Riya Susan Chacko, MD, Joseph Battaglia, MD, FACC, and Megan McCabe, RN, BSN, Nurse Manager

Established in the early 1980s, what is now Crouse Medical Practice Cardiology gradually grew from a single-physician organization to one of the largest and most diverse cardiology practices in the region. The practice features 12 cardiologists with expertise in interventional and diagnostic cardiology, electrophysiology, nuclear cardiology, congenital heart disease and heart failure, among others, as well as four nurse practitioners. Crouse Medical Practice Cardiology’s team is a blend of clinicians with decades of experience in the field and those who have completed their training more recently. All clinicians, however, bring new treatment techniques to the service line.

Joseph Battaglia, MD, FACC, interventional cardiologist and a founding partner of Crouse Medical Practice Cardiology, joined the practice shortly after it was established in 1985 and has been present for its important milestones, including when the practice joined Crouse Health in 2015.

“Crouse Health recognizes the importance of cardiac care services to Central New York and has been extremely supportive of our practice,” Dr. Battaglia says. “Crouse Medical Practice Cardiology has always had a culture that prioritizes listening to patients and doing what’s best for them above all, and Crouse Health shares that culture.”

Care Rooted in Collaboration

To the members of Crouse Medical Practice Cardiology, the group’s culture, more than any other factor, distinguishes the practice from others in Central New York. A spirit of collaboration that encompasses not only the members of the practice, but also the specialists with whom the cardiologists consult and the physicians who refer patients to Crouse Medical Practice Cardiology, is the group’s defining trait.

“Our clinic is a general cardiology clinic, so we see patients with all sorts of cardiac conditions,” says John Ulahannan, MD, one of Crouse Medical Practice Cardiology’s newest members and a specialist in interventional cardiology. “Often, I’ll consult a colleague for advice on cases when I know they’ll have valuable insights. Patients want that kind of team-based approach. One cardiologist quarterbacks a patient’s care, but everyone is needed. That’s what makes a good team.”

“Each member of the practice brings unique strengths and skills, and my partners and I leverage that expertise every day,” Dr. Battaglia says. “I may ask a colleague who specializes in cardiac MRI whether an MRI would benefit a certain patient. Other partners may ask their colleagues who are experts in electrophysiology about the best way to manage patients with particular heart rhythm problems. When patients receive care from one of us, they receive it from all of us.”


Seth Kronenberg, MD, Chief Medical Officer and Chief Operating Officer at Crouse Health

An important member of every patient’s care team is the physician who refers him or her to Crouse Medical Practice Cardiology, which is why the members of the practice go to great lengths to seek input from the clinicians who know patients’ medical histories best, and keep them informed as individuals’ cardiac care progresses.

“Our cardiologists aren’t consultants — they are highly trained physicians who treat patients like family through the entire care journey, not just acute episodes,” says Seth Kronenberg, MD, Chief Medical Officer and Chief Operating Officer at Crouse Health. “They excel at coordinating care around a cardiac condition, and they see themselves as partners with the other physicians who may be caring for each patient.”


Lynne Shopiro, RN, BSN, Interim Chief Nursing Officer and Director of Cardiac Care Services at Crouse Health

The same holds true for the cardiologists’ collaboration with the outstanding team of nurses at Crouse Health’s Diane and Bob Miron Cardiac Care Center, where the physicians provide a variety of interventional and diagnostic services. Crouse Health Interim Chief Nursing Officer and Director of Cardiac Care Services Lynne Shopiro, RN, BSN, has been involved in heart care at Crouse Health for more than 35 years. The physicians of Crouse Medical Practice Cardiology are integral to the hospital’s success in building a well-regarded cardiac service line, Shopiro notes, in part because of the high standards they bring to the Miron Cardiac Care Center.

“From the nurses’ perspective, the cardiologists’ ability to teach and the high expectations they have for quality care make the Miron Cardiac Care Center team better,” Shopiro says. “The nurses care for patients in conjunction with the cardiologists, and the collaboration between the two teams is phenomenal.”

Championing Women’s Heart Health

Every 80 seconds, cardiovascular disease claims a woman’s life in the United States, according to the American Heart Association, but under-recognition by women and healthcare providers of this threat remains a significant barrier to saving lives. Despite cardiovascular disease’s distinction as the leading cause of death for women in the U.S., a 2015 study in the Journal of the American College of Cardiology found women age 55 and younger were 11 percent less likely than men to be told they were at risk for heart disease prior to a heart attack, even when their risk was comparable to or greater than men’s. Women in the study were 16 percent less likely than men to report having a discussion with their healthcare provider about risk reduction.

Certain risk factors, such as diabetes and hypertension, increase women’s risk for cardiovascular disease more than men’s. Others, such as preeclampsia, gestational hypertension and gestational diabetes, are unique to women, who tend to develop heart disease 10 years later than men due to menopause, according to the Federal Office on Women’s Health. Women also have a well-documented propensity to experience different acute coronary symptoms than men.

Combating Gender Bias

Differences in risk factors and symptoms, however, do not fully explain why cardiovascular disease remains a disproportionately potent threat to women, says Riya Susan Chacko, MD, cardiologist at Crouse Medical Practice Cardiology, who has a special interest in women’s heart health and serves on the American College of Cardiology’s Women in Cardiology Section.

“Sometimes, women are treated differently,” Dr. Chacko says. “Gender bias still exists in health care, where the thinking may be that men develop heart disease, but it’s not an issue for women. Another problem is that women tend to minimize their symptoms. They may say to their physician, ‘I’m having chest pain, but it’s probably nothing.’ When women say that, physicians sometimes follow their lead.”

Dr. Chacko advises primary care physicians and other providers to investigate any symptoms women report, including pain that radiates to the jaw, back or arm, as well as perspiration and nausea —heart attack symptoms that women may be more likely than men to experience. Referral to a cardiologist is appropriate if a patient experiences any new or concerning symptoms, receives an abnormal electrocardiogram result, or has an intermediate or high risk for cardiovascular disease, based on lifestyle and familial risk factors.

At Crouse Medical Practice Cardiology, women’s heart health is a key area of focus.

“Our practice is committed to women’s heart health, just as Crouse Health is” Dr. Chacko says. “Inclusion, commitment, education and quality are the principles that guide our patient care philosophy.”


Learn why cardiac care is personally important to Dr. Chacko at carepassion.org/drchacko.

Award-Winning, Pioneering Interventional Cardiology

Complementing Crouse Medical Practice Cardiology’s ethos of collaboration is a commitment to providing comprehensive cardiac care, starting with interventional cardiology. The Miron Cardiac Care Center features the latest technology, including three cardiac catheterization suites, among them the only one in the region for pediatric patients (see “Seamless Care for the Youngest Cardiac Patients”). Drs. Battaglia and Ulahannan, as well as interventional cardiologist Anil George, MD, FACC, perform a variety of procedures, including coronary artery angioplasty and stenting, and peripheral vascular interventions. The interventional cardiologists are especially adept at treating ST-elevation myocardial infarction (STEMI).

“Once emergency medical services personnel in the field or physicians in Crouse Health’s Pomeroy Emergency Services Department diagnose STEMI on an electrocardiogram, they activate the cardiac catheterization team, which typically consists of an interventional cardiologist and three nurses,” Dr. Ulahannan says. “All Crouse Medical Practice Cardiology members live within a 30-minute radius of Crouse Health, so if the activation goes out, we can get to the hospital quickly to meet patients when they arrive.”


Cardiac Catherization Lab Nurse Team

Thanks to the skills of the interventional cardiologists and other members of the cardiac catheterization team, Crouse Health boasts rapid door-to-balloon times — from the time the patient arrives at the emergency room to the restoration of blood flow in an occluded artery using balloon angioplasty — that consistently exceed national benchmarks. According to Dr. Battaglia, Crouse Health’s door-to-balloon time is approximately 50 minutes, which is significantly faster than the national goal of 90 minutes. In 2018, that achievement helped Crouse Health earn the American Heart Association (AHA) Mission: Lifeline Gold Receiving Quality Achievement Award for STEMI, the only hospital in the area to receive this designation.

To perform most cardiac catheterizations, whether diagnostic or emergent, Drs. Battaglia, Ulahannan and George access the arterial system through the radial artery in the arm rather than the femoral artery in the groin, an approach with a variety of benefits for patients.

“We perform more than 90 percent of cardiac catheterizations via the radial artery,” Dr. Ulahannan says. “Using the radial artery causes less discomfort and carries a lower risk of bleeding-related complications at the point of access because the radial artery is smaller than the femoral. With the femoral approach, patients are bed-bound for two to four hours postprocedure, and for people with chronic back or neck pain, lying flat in a bed for that length of time is difficult. Patients who receive the radial approach can sit up immediately after the procedure and ambulate more quickly.”

“I joined Crouse Medical Practice Cardiology from a local hospital in 2016 because of the practice’s diversity — we have an excellent mix of established and newer clinicians from a variety of professional backgrounds — and the way we practice medicine. Health care has become disjointed and compartmentalized at so many practices and hospitals, but not here. My partners and I care for patients as one team.”
— Riya Susan Chacko, MD, cardiologist at Crouse Medical Practice Cardiology

Comprehensive Services Driven by Technology

Interventional cardiology is just one component of Crouse Health’s extensive cardiac care service profile. The team at Crouse Medical Practice Cardiology also offers a variety of diagnostic tests at the Miron Cardiac Care Center, including echocardiography — the Intersocietal Commission for the Accreditation of Echocardiography Laboratories awarded Crouse Health’s echocardiography lab accreditation in Adult Transthoracic, Adult Transesophageal and Adult Stress — cardiac MRI, cardiac CT, angiography and nuclear cardiology.


Riya Susan Chacko, MD, cardiologist at Crouse Medical Practice Cardiology, and Kwabena A. Boahene, MD, FACC, confer on a patient record.

“When we compare the results of our team’s nuclear cardiology studies to what we find during procedures in the cardiac catheterization labs, we find the former to be extraordinarily accurate,” Dr. Battaglia says. “The quality of their studies is impressive. That’s true of the echocardiography department, as well. We know we can rely on the team there to obtain the information we need with a transthoracic or transesophageal study.”

Crouse Health features a robust electrophysiology program. Crouse Medical Practice Cardiology members Nikhil Joshi, MD, and Kwabena A. Boahene, MD, FACC, perform a variety of procedures in the electrophysiology suite, including ablations to treat atrial fibrillation, ventricular tachycardia and supraventricular tachycardia. They also provide pacemaker and defibrillator implantations. The newest therapy in the electrophysiologists’ repertoire is the Micra Transcatheter Pacing System. Approved as an alternative to conventional, single-chamber pacemakers for the treatment of bradycardia, Micra is a small, leadless pacemaker that an electrophysiologist places via catheter directly into a patient’s heart. No chest incision is required for implantation, and the device eliminates the possibility of lead-related complications that can occur with conventional pacemakers.

Micra is a technology that is changing the way cardiologists at Crouse Health care for patients, but it is not the only example. Another is Watchman, a small device that can reduce the risk of stroke due to atrial fibrillation in patients who cannot tolerate anticoagulation therapy. Implanted during an outpatient, catheter-based procedure, Watchman fits inside the left atrial appendage (LAA), a pouch in the heart where blood may pool and clot in patients with atrial fibrillation, increasing their risk of stroke. Watchman occludes the LAA and has been shown to be as effective as anticoagulation therapy at reducing stroke risk. In 2017, Crouse Health introduced Watchman to Central New York when Drs. Battaglia and Boahene and their Crouse Medical Practice Cardiology partner Matthew Gorman, MD, FACC, became the first cardiologists in Syracuse to implant the device and today perform more of these procedures than any other area hospital.

Another example of Crouse Medical Practice Cardiology’s embrace of innovative devices is its members’ use of Impella, a small heart pump that can ensure blood flow continues during a high-risk percutaneous coronary intervention or when patients experience cardiogenic shock.

“Whether cardiogenic shock occurs in the setting of an acute heart attack or severe heart failure in which the heart can’t pump effectively to provide blood to the rest of the organs, we can introduce Impella through a sheath in the femoral artery and place it inside the left ventricle, where it does the work of the heart while the organ heals,” Dr. Ulahannan says. “Impella is fairly new on the medical landscape. I find it amazing that it can support someone who’s actively dying.”

Crouse Health has earned plaudits for its treatment of patients with heart failure. Last year, the AHA awarded the health system its Get With The Guidelines–Heart Failure Gold Plus Quality Achievement Award for providing excellent care based on national guidelines.

Poised to Expand

Demand for cardiac services in Central New York is likely to increase in the future, and Crouse Medical Practice Cardiology, with enthusiastic support from Crouse Health’s Senior Leadership team, is well positioned to meet it.

“I envision more growth for the practice and continuing the spirit of cooperation with the health system administration that allows us to work so well with Crouse Health now,” Dr. Battaglia says. “The high quality Crouse Medical Practice Cardiology provides today will only be enhanced, given that our newer partners are so talented.”

As the practice takes cardiac care in Central New York into the future, its lodestar — collective expertise and unwavering focus and attention on the patient — will remain constant.

“When referring physicians send their patients to us, they don’t get one of us — they get all of us,” Dr. Battaglia says. “Their patients enter a practice and a health system where everyone works together for the people in our care.”


Meet the Members

Crouse Medical Practice Cardiology includes:


Jeffrey Ascenzo, MD, FACC
 

Joseph Battaglia, MD, FACC

William Berkery, MD, FACC
 

Kwabena Boahene, MD, FACC

Riya Susan Chacko, MD
 

Anil George, MD, FACC
 

Matthew Gorman, MD, FACC

Joshua Harrison, MD
 

Nikhil Joshi, MD
 

James Longo, MD, FACC
 

John Ulahannan, MD
 

Fafa Xexemeku, MD
 

For more information about the physicians of Crouse Medical Practice Cardiology and cardiac services at Crouse Health, visit crouse.org/services/cardiac-care.