O u t c o m e report 2 0 1 5

Cardiology

OVERVIEW

EINSTEIN CARDIOLOGY PROGRAM

MEDICAL STAFF

QUALITY AND CLINICAL OUTCOMES

PATIENT EXPERIENCE

TEACHING AND SCIENTIFIC EVENTS

RESEARCH AND SCIENTIFIC PRODUCTION

SOCIAL RESPONSIBILITY

BRAND DISSEMINATION AND MANAGEMENT

STAFF & CONTACT INFORMATION

07

14

18

21

45

47

53

58

60

63

3

Message from the President

Throughout the pages of this report,

we share information about the main

achievements and indicators of Einstein

Cardiology Program in 2015, comprising

clinical care, teaching, research and social

responsibility activities. Much more than

a balance of the year for this strategic

specialty at Einstein and a significant

reference for our management and

improvement processes, this report is

an exercise of transparency, including

contents that will interest everyone.

After all, information is a key element to

guide choices and decisions of physicians

and patients, in addition to inspire the

multiplication of practices of excellence

throughout Brazil. And we, as widely

recognized, do have them. Platinum

Performance Achievement Award by

American College of Cardiology is simply

one example.

In addition to awards, there are other

ways to confirm what makes Einstein

Cardiology a reference in the area. One

of them is to observe the performance

indicators of care, which level up - or

even outperform – those of the best

organizations in the world. Results such

as these are only achieved by a restless

organization, permanently searching

for more and better performance. For

those who, like us, place the patient in

the center of care, this is the only way

to go. And patients can recognize it.

Einstein Cardiology’s heart is beating up and strongly to the benefit of patients, physicians, staff and the society as a whole.

4

Quality of care, humanized approach,

competence and dedication of our

clinical staff and multidisciplinary

clinical team can certainly account for

the 89% average satisfaction rate of

inpatients.

Concerning teaching and research

activities, the year was highly

dynamic. We have increased the offer

for graduation courses, professional

improvement courses and distance

learning. We have also expanded

the number of research projects,

both submitted and ongoing, and

scientific publications, most of which

in journals with impact factor higher

than 1. Among the new research lines

(all of them guided towards Aging),

it is worth mentioning behavioral

cardiology, a new frontier of studies in

the area.

Regarding Social Responsibility, the

number of heart transplants performed

through the Universal Public

Healthcare System (SUS) deserves to

be highlighted: over 80% of the total

number of procedures in the year.

Another point to strengthen is the

diagnostic and therapeutic support

provided to

public hospitals through

Telemedicine. Protocols and

quality indicators, projects that

improve and expand our activities,

incorporation of new technologies,

qualified professionals who

are constantly updating their

knowledge, generation and

dissemination of information, social

actions… Altogether, they convey

additional vitality to our Cardiology.

The pages that follow will bring

to readers detailed information

about these and other important

achievements in 2015. However,

in a nutshell, this report shows

that Einstein Cardiology’s heart is

beating strongly and healthy to the

benefit of patients, physicians, staff

and the society as a whole.

Claudio Lottenberg

President of Sociedade Beneficente Israelita Brasileira Albert Einstein

We place the patient in the center of care, which is the only way to go. Quality of care, humanized approach, competence and dedication of our clinical staff and multidisciplinary clinical team can certainly account for the 89% average satisfaction rate of inpatients.

5

IntroductionIn 2015, year of the 60th anniversary of

Sociedade Beneficente Israelita Brasileira

Albert Einstein, the Cardiology Program

grew and was transformed. There were

many opportunities to further strengthen

the relationship among the professionals

directly and indirectly involved with

clinical care, always focusing on providing

better care, a welcoming environment and

additional safety to our patients.

In the clinical arena, there was a

21.5% increase in acute myocardial

infarction cases compared to 2014. As a

consequence of the continuous quality

management improvement in providing

care and treatment to these patients, we

were recognized by the American College

of Cardiology through the Platinum

Performance Achievement Award. This

important award states the stability

of the indicators, which measured for

eight consecutive quarters above 90%

of the remaining participants of ACTION

Registry®–GWTG™.

Concerning technological innovation,

the Arrhythmia Center has stood out in

two fronts – pioneer in Brazil in adopting

focal cryoablation for treating arrhythmia

in adult and pediatric patients and in

outpatient electrical cardioversion for

treating atrial arrhythmia. As to imaging

in Cardiology, there was the incorporation

of the 640-slice angio-CT of the coronary

arteries and the Interventional Cardiology

Center performed the first procedures

with Mitraclip® for mitral valve

regurgitation repair.

In the surgical area, the volume of

heart transplants increased by 43% in

2015, amounting to 30 cases in the

year and placing Einstein as the second

largest heart transplant center in the

state of Sao Paulo. Minimally invasive

heart surgery played a key role in the

Mitral Conclave, held during the AATS

Annual Meeting (American Association

for Thoracic Surgery) in April 2015,

in Seattle, USA. In addition, there was

the incorporation of cardiac surgery

into the Surgical Code, which calls the

heart surgical team for implants of

different circulatory support modalities

(Program of Circulatory Support) and the

performance of urgency and emergency

heart procedures.

As to teaching, Non-Degree Graduate

Studies expanded their activities thanks

to the beginning of the operation in

the Teaching Unit in Rio de Janeiro.

Concerning advanced learning programs,

two new courses were offered in

2015: transplant and cardiac failure

to clinicians and heart transplant

and mechanical circulatory support

to surgeons. Through the distance

teaching platform, Einstein Cardiology

has provided four courses that involve

professional expertise.

In 2015, the area of cardiovascular

6

“The Cardiology Program has been

transformed. We have strengthened the

relationship among professionals involved

in care and provide better clinical care, a

welcoming experience and additional safety

to our patients.”Márcia Makdisse

“In 2015, we were granted the Platinum

Performance Achievement Award by

the American College of Cardiology, an

important recognition of the quality of care

and treatment provided to our patients.”

Marcelo Franken

research published 77% of their

production in scientific journals with

impact factor > 1, in addition to a

37% increase in number of submitted

or ongoing projects in the Research

project management system (SGPP

– Sistema de gestao de projetos de

pesquisa). A study that deserves to be

highlighted included data from 24,000

checkup tests performed at Einstein,

which was selected among the best

papers at the European Congress of

Cardiology in 2015 due to its original

design and important results.

We would like to invite you to visit

the page of the Cardiology Program

at Einstein website (www.einstein.br/

en/specialties/cardiology), where it is

possible to see additional information

about our service structure, news,

educational contents, information

about new courses and quality

indicators.

Marcia Makdisse

Medical Manager of the Cardiology Program (2005 – April 2016)

Marcelo Franken

Medical Manager of the Cardiology Program (May 2016 – to date)

7

Overview

Hospital Israelita Albert Einstein is a nonprofit general hospital focused on high-complexity and capable of covering all healthcare dimensions: promotion, prevention, diagnosis, treatment and rehabilitation.

Hospital Israelita Albert Einstein

5.3% Growth in number of outpatient visits

45.7%Increase in total number of tests performed in 2015

4.5% Increase in number of credentialed physicians at Einstein

18.7%

Increase in volume of performed surgical procedures

8

Hospital Israelita Albert Einstein

Medicina Diagnóstica e Preventiva

(Preventive and Diagnostic Medicine)

Instituto Israelita de Ensino e Pesquisa

(Teaching and Research)

Instituto Israelita de Responsabilidade Social(Social Responsability)

Instituto Israelita de Consultoria e Gestão

(Consulting Management)

EINSTEIN FIGURES AND FACTS 2014 2015 Variation

Number of operational bed 657 615 -6.4%

Number of ICU beds (Adults) 48 44 -8.3%

Number of patients/ day 201,206 196,726 -2.2%

Mean length of stay (in days) 4,12 3,91 -5.2%

Occupancy rate 84.9% 84.9% 0.3%

Hospital Discharges Total - Morumbi

- Vila Mariana- Perdizes

52,10551,842

2585

53,25253,128

1195

2.2%2.5%

-53.9%0.0%

Sirurgical procedures Total - Morumbi- Perdizes

36,88635,523

1,363

43,77842,262

1,516

18.7%19.0%11.2%

Deliveries 4,449 4,669 4.9%

Tests Total- Morumbi

- Alphaville- Jardins

- Ibirapuera- Perdizes

- Cidade Jardim

5,871,0683,607,361

554,563442,546621,528614,295

30,775

8,556,6156,140,418

591,266457,959678,997653,646

34,329

45.7%70.2%

6.6%3.5%9.2%6.4%

11.5%

Visits (Outpatients) Total- Morumbi

- Alphaville- Perdizes

292,831236,439

46,01410,378

308,465246,038

46,32716,100

5.3%4.1%0.7%

55.1%

ED Visits Total- Morumbi

- CMA- Oncologia- Alphaville- Ibirapuera

- Perdizes

321,196128,724

1,807-

53,92378,84557,897

330,283130,943

1,495412

55,42282,26559,746

2.8%1.7%

-17.3%-

2.8%4.3%3.2%

Open clinical staff (physicians) 7,40311,572

7,73512,755

4.5%10.2%

9

OverviewEinstein Cardiology

2015 was a period of growth and transformation for Einstein Cardiology, by expanding the volumes and revenues, and increasing quality of care, safety and wellbeing of patients.

8 Mitral valve repair using catheter – Mitraclip

7

Robotic minimally invasive cardiac surgeries

17 Minimally invasive cardiac surgeries

30Heart Transplants

10

2014 2015 Variation

Preventive Cardiology

Preventive Medicine Center Performed checkups 9,869 10,728 8.0%

Medical visits

Outpatient Medical Center

Visits performed (Cardiology/ Cardiac Surgery)

25,908 27,992 8.0%

Total number of cardiologists and cardiac surgeons involved

101 120 18.8%

Emergency Department

ED - Morumbi

Total visitsCardiology Cases

10,7968.626

14,30811,259

24.5%23.4%

Chest pain visits 2,170 3,049 28.8%

Diagnostic Cardiology

Diagnostic Center Cardiopulmonary

Total tests 69,744 74,076 5.8%

Echocardiography

Morumbi 20,272 22,017 7.9%

Jardins 4,251 4,206 -1.1%

Alphaville 2,846 3,189 10.8%

Perdizes-Higienópolis 2,700 2,806 3.8%

Tracing Methods (Stress Test, ECG and MAPA)

Morumbi 17,964 18,735 4.1%

Jardins 14,320 15,176 5.6%

Perdizes-Higienópolis 3,476 3,648 4.7%

Alphaville 3,090 3,460 10.7%

Ibirapuera 769 781 1.5%

Cidade Jardim 56 58 3.4%

Cardiology Imaging Total tests 6,264 6,251 -0.2%

Myocardial Scintigraphy Morumbi 3,569 3,501 -1.9%

Coronary Angio-CT

Morumbi 1,919 1,933 0.7%

Perdizes-Higienópolis 265 251 -5.6%

Alphaville 125 131 4.6%

Heart MRI

Morumbi 335 359 6.7%

Perdizes-Higienópolis 13 41 68.3%

Ibirapuera 10 22 54.5%

Alphaville 28 13 -115.4%

11

2014 2015 Variation

Arrhythmia

Non-invasive Electrophysiology

Total tests 3,703 3,903 5.1%

Holter 2,507 2,637 4.9%

Tilt Test 777 722 -7.6%

Web-looper 151 168 10.1%

Assessment of implantable devices 106 147 27.9%

Heart MAPA 68 116 41.4%

Specialized Opinion (1st /2nd opinion)

56 79 29.1%

High-resolution Electrocardiogram 36 28 -28.6%

Wave T micro-alternation 1 0 -

Ajmaline test 1 0 -

Outpatient electrical cardioversion 0 6 100.0%

Invasive Electrophysiology

Total procedures 230 249 7.6%

Device implant 138 131 -5.3%

Arrhythmia ablation 82 108 24.1%

Isolated Electrophysiological Study 10 10 0.0%

Admissions – Adults

Clinical Surgical (Wards)Total admissions 8,226 8,948 8.1%

Heart admissions 2,094 2,334 10.3%

Intensive Care UnitTotal ICU admissions 3,087 3,673 16.0%

Cardiology admissions 619 593 -4.4%

Coronary Unit (UCO)Total UCO admissions 1,386 1,421 2.5%

Cardiology admissions 1,040 927 -12.2%

Main diagnoses

Acute coronary syndrome (total) 708 772 8,.3%

Arrhythmias 436 461 5.4%

Heart failure (total) 445 412 -8.0%

Heart failure (systolic) 299 363 17.6%

Acute myocardial infarction 216 275 21.5%

Hypertension emergencies 112 96 -16.7%

12

2014 2015 Variation

Pediatric Admissions

Volume Cardiology admissions 414 497 16.7%

Main Diagnoses

General Cardiology 326 403 19.1%

Arrhythmias 43 46 6.5%

Hypertensive Emergencies 36 34 -5.9%

Heart failure 8 7 -14.3%

Aortic disease 1 5 80.0%

Acute coronary syndrome 0 2 100.0%

Center of Cardiovascular Interventions

Interventional Cardiology

Heart catheterization 898 876 -2.5%

Percutaneous coronary intervention 492 517 4.8%

IVUS/OCT/FFR 131 166 21.1%

Catheter-guided aortic bioprosthesis implant

32 21 -52.4%

Rotational aterectomy 5 11 54.5%

Intervention in congenital cardiopathy 7 5 -40.0%

Mitral failure repair guided by catheter – Mitraclip

0 8 -

Installation of BIA/Impella 6 6 0.0%

Vascular Interventional Radiology

Diagnostic tests 468 406 -15.3%

Chemoembolization 189 144 -31.3%

Biliary Intervention 95 88 -8.0%

Embolization procedures 43 48 10.4%

Radioembolization – Phase 1- Assess 3 43 93.0%

Percutaneous transluminal angioplasty

45 32 -40.6%

Radioembolization –Phase 2 Injection of radioactive spheres

2 27 92.6%

Vena cava filter placement 7 7 0.0%

Thrombolysis / thrombectomy 9 5 -80.0%

Interventions in aorta disease 17 3 -466.7%

Placement of central venous catheter/ port-o-cath

10 1 -900.0%

Transjugular intra-hepatic systemic shunt

8 1 -700.0%

13

2014 2015 Variation

Cardiovascular Surgery

Type of approach

Conventional 126 188 34.0%

Minimally Invasive (Total) 16 17 5.9%

Robotic Minimally Invasive 6 7 14.3%

Performed Procedures

Higher-complexity Procedures 140 179 21.8%

Valve Surgery 52 60 13.3%

Myocardial Revascularization 43 56 23.2%

Heart Transplant 17 30 43.3%

Repair of congenital cardiopathy 28 33 15.2%

ECMO Implants 3 8 62.5%

Ventricular Assist Devices 8 3 -166.7%

Lower-complexity Procedures 211 218 3.2%

Implant of cardiac devices (pacemaker, CRT, ICD)

138 131 -5.3%

Hybrid Room

Performed Procedures 146 170 14.1%

Cardiac 61 74 17.6%

Vascular 65 40 -62.5%

Digestive tract 4 29 86.2%

Fetal medicine 3 13 76.9%

Oncology 1 6 83.3%

Thoracic 3 4 25.0%

Gynecology and Obstetrics 4 2 -100.0%

Orthopedic 2 2 0.0%

Neurological 3 1 -200.0%

Exercise and Sport Cardiology

Cardiopulmonary Rehabilitation Performed appointments 4,703 4,918 4.4%

Sport Cardiology Professional athlets assessed 83 80 -3.8%

14

Einstein Cardiology ProgramCardiology is one of Einstein’s strategic specialties.

Main objectives of the Cardiology Program

• Encourage interaction with the Clinical Staff

• Promote integration between the clinical care units and the cardiology patient

• Create and manage protocols and quality and safety indicators for cardiology patients

• Design and implement a strategic plan that leads to new challenges, continuous

improvement and incorporation of new technologies

• Develop teaching, research and social responsibility in the specialty.

15

Timeline Main highlights

• Beginning of the Medical Residency Program in Cardiology

• I Einstein International Symposium in Cardiology Surgery Minimally invasive

• Creation of the Sport Cardiology Center

• Creation of the Heart Team

• II Einstein International Symposium of Minimally Invasive Cardiac Surgery and I Einstein International Symposium of Thoracic Oncology

• Creation of the Cardiovascular Research Support Center (NAPEC – Nucleo de Apoio a Pesquisa Cardiovascular)

• Opening of the new Cardiovascular Intervention Center

• Opening of phase I of Hybrid Room

• Creation of Einstein Central Unit for Holter

• Opening of phase II of Hybrid Room

• Beginning of the Post Graduate Studies in Cardiology for Physicians

• Creation of the Pediatric Cardiology and Cardiac Surgery Center

• Creation of the Cardiology Teaching Support Center (NAEC – Nucleo de Apoio ao Ensino em Cardiologia)

• Creation of Core Lab (Angiographic Imaging Laboratory)

• Creation of the Support Center to Development of Cardiology Products (NAC – Nucleo de Apoio ao Desenvolvimento de Produtos da Cardiologia)

• Inclusion in ACTION Registry of American College of Cardiology (NCDR)

• Publication of a Cardiology special edition of Revista Einstein

• Creation of the Medical Care Group (Grupos Medico-Assistenciais - GMA) of metabolic syndrome, Endovascular intervention and Cardio-Oncology

• Coordination of the Brazilian Registry of Catheter-Guided Implantation of Aortic Bioprostheses

2011 2013

2012

• Recognition as Founding Ambassador of American College of Cardiology’s International Cardiovascular Data Registries

• Recognized as Center of Excellence for Treatment of Infarction by American College of Cardiology

• Implementation of the Institutional Program of Circulatory Support

• Implementation of the Institutional Protocol of Cardio Oncology

• Performance of the first pediatric heart transplant

• Creation of the Patient Relations Center

• Platinum Performance Achievement Award by American College of Cardiology

• Creation of the Circulatory Support Program

• Creation of the high complexity scheduling center

2015

2014

16

TimelineTechnology incorporation

• Echocardiography with strain 2D and 3D analyses

• Bioabsorbable Stent – BVS (clinical trial)

• Percutaneous closure of Paravalvar leak

• Fully robotic myocardi-al revascularization

• Cath Lab with Xpert CT (CT images during procedures)

• Telemedicine for cardiology and cardiac surgery assessment

• Optical Coherence CT

• Angio CT of coronary arteries under pharmacological stress

• ONIX embolizing agent in endovascular procedures

• Hybrid Room with Da Vinci System and Arts Zeego

2011 2013

2012

• 320-Slice Coronary Artery Angio CT (Aquillion One Vision Edition)

• Cryoablation for treatment of cardiac arrhythmia (adults)

• Radioembolization for treatment of tumors

• Cath Lab with Biplan Equipment with Software Clarity (lower exposure to radiation)

• Centrimag System (ventricular assist device)

• Bioabsorbable Stent – BVS (clinical use)

• 640-slice Angio-CT of coronary arteries

• Focal Cryoablation for the treatment of arrhythmias (children)

• Outpatient Electrical Cardioversion

• Mitraclip

2015

2014

Organization Flow Chart 2016

DIAGNOSTIC AND PREVENTIVE MEDICINE

Eliezer Silva

PREVENTIVE MEDICINE CENTER

Raquel Conceição

CHECK-UP UNIT

Viviane Tabone

CARDIOVASCULAR PREVENTIONRaul Dias

CARDIOPULMONARY DIAGNOSTIC CENTER

Samira Morhy

ECHOCARDIOGRAPHY

Claudio Fischer

GRÁPHIC METHODS

Romeu Meneghelo

PULMONARY FUNCTION

Eduardo Meyer

INTERVENTIONAL IMAGING

Rodrigo Gobbo

SEVERELY-ILLPATIENTS

Leonardo Rolim

INTERVENCIONALVASCULAR RADIOLOGY

Felipe Nasser

CARDIOVASCULAR INTERVENTION CENTER

Marcelo Franken

CORONARY UNIT

Marcelo Franken

INTERVENCIONALNEURORADIOLOGY

INTERVENCIONALELECTROPHYSIOLOGY

Guilherme Fenelon

CENTERS OF EXCELLENCE

ARRHYTHMIA CENTER

Guilherme FenelonElisabete Guedes

INSTITUTIONAL CARDIAC SURGERY

Robinson Poffo

HEART TRANSPLANT

Fernando BacalRobinson Poffo

SPORT CARDIOLOGY

PEDIATRIC CARDIOLOGY

STRATEGICS AND SERVICE DEVELOPMENTMarcia Makdisse

CARDIOLOGY PROGRAM

Marcelo Franken

HEALT ECONOMICS RESEARCH SUPPORT CENTER (NAPES)

Marcelo Katz

EMERGENCY DEPARTMENT

José Carlos Teixeira

INPATIENTS

Claudia Laselva

CARDIOLOGY INPATIENT UNIT

Wagner Bezerra

CARDIO-PULMONARY

REHABILITATION

Flavia Camargo

QUALITY & SAFETY

CLINICAL RECORDS

Patrícia AlliegroPaula Yokota

CARDIOLOGY SUPPORT GROUP

Antonio Eduardo Pesaro

SUPPORT CENTER

CARDIOVASCULAR RESEARCH SUPPORT

CENTER (NAPEC)

Marcelo KatzCarolina Pereira

CARDIOLOGY TEACHING SUPPORT

CENTER (NAEC)

Antonio Bacelar Nunes Filho

HOSPITAL ISRAELITA ALBERT EINSTEIN Miguel Cendoroglo Neto

INTERVENCIONALCARDIOLOGY

Adriano Caixeta

18

Medical Staff

The Medical Staff is comprised of 397 clinical cardiologists, 76 cardiac surgeons, 3 interventional radiologists and 5 pediatric cardiologists.

19

Specialty Total

Clinical Cardiology 56

Arrhythmia and cardiac dysautonomia 6

Heart transplant evaluation 1

Pediatric Cardiology 2

Sport Cardiology 2

Adult and adolescent congenital cardiopathy 3

Cardiopathy and pregnancy 1

High complexity cardiac valve disease 2

Cardiac surgery 6

Robotic and minimally invasive cardiac surgery 1

Pediatric cardiac surgery 1

Heart Transplant 1

Specialty Premium Advance Evolution Special Total

Cardiologists 28 72 99 198 397

Pediatric Cardiologists 1 0 1 3 5

Cardiac surgeons 6 6 11 53 76

Total 35 78 111 254 478

Relationship Program

The Clinical Staff Relationship Program uses merit criteria to acknowledge participating

physicians, dividing them into Premium, Advance, Evolution and Special categories. The

physicians’ performance is assessed based on over 60 criteria encompassing four pillars:

Teaching and Research, Loyalty, Quality and Social Responsibility.

CLINICAL STAFF – SEGMENTATION 2015/2016

Medical Indicator

It is formed by 62 physicians, distributed by specialty and areas of interest.

Names and contact information of the physicians may be accessed in the

internet. (click here).

20

Feedback ProjectAll physicians may access their performance data related with the four pillars of the Relationship

Program, which include compliance with protocols and best clinical practices. They are

available in the internet, controlled by individual login and password (click here). Moreover, 72

cardiologists and 5 cardiovascular surgeons received face-to-face individual feedback in 2015.

Program of Hybrid Physicians and NursesThe so-called hybrid professionals are hired by the clinical units and have allocated timed to

take part in projects of quality and safety, teaching, research, telemedicine, Heart team, and

heart transplant, among others. In 2015, 22 professionals worked as hybrid staff, comprising 20

physicians and 2 registered nurses.

Medical Council and Breakfast with the Clinical StaffComprised by hired and independent physicians of the clinical staff and the leadership of the

Cardiology Program and Sociedade Beneficente Israelita Brasileira Albert Einstein, the Medical

Council meets periodically. In 2015, there were three meetings that involved cardiologists from

the credentialed clinical staff, hired professionals and resident physicians.

Cardiology Support GroupFormed by cardiologists working in the Coronary Unit, Emergency Department, Intensive

Care Unit and Cardiology Program, the Cardiology Support Group actively contributes to

improve quality of care and scientific production. It gathers hired professionals with confirmed

experienced in Cardiology, in their own subspecialties, aligned with the strategic programs and

hospital GMAs.

Clinical care: Development and update of clinical protocols for AMI, heart failure, venous

thromboembolism prophylaxis, perioriperative cardiac surgery, and preoperative care of aortic

surgery. They also act as on-demand consultants in the Pharmacy commissions and in the

analyses of Severe Adverse Events.

Education and Research: Continuing medical education (classes, online education materials and

training courses), graduate studies and contributions to cardiovascular clinical research studies.

In 2015, they participated in 10 international publications in indexed journals, amounting to

about 15% of the production in Cardiology for the entire organization.

21

Quality and Clinical OutcomesMonitoring quality of care provided to patients and the continuous analysis of outcome and performance indicators enable Hospital Israelita Albert Einstein to manage risks and make quick decisions for constant improvement.

22

ACUTE MYOCARDIAL INFARCTION (AMI)

Since 2013, Einstein has been part of the ACTION Registry®– GWTG™, which is the database that

monitors quality of care provided to inpatients with the diagnosis of AMI. Throughout the years,

the hospital was acknowledged as an International Center of Excellence by the American College of

Cardiology.

In 2015, the overall performance of the hospital in AMI care was 90.7%. The difference is primarily due to cardiac rehabilitation referral. Actions to improve this indicator are already underway.

95.390.7

95.2

0

20

40

60

80

100%

Einstein 2014 Einstein 2015 RegistryACTION 2015

It includes 11 quality indicators, depending on patient eligibility: Acetylsalicylic acid (AAS) at arrival

and discharge; beta-blockers at discharge; statin at discharge; angiotensin-converting enzyme

inhibitors or angiotensin-receptor blockers (ACEI/ ARB) at discharge; assessment of cardiac function;

reperfusion therapy; fibrinolysis time, when eligible; door-to-balloon time, when eligible; smoke

cessation education, and cardiac rehabilitation referral.

OVERALL PERFORMANCE OF AMI CARE

23

In 2015, Einstein reached 93.3% in STEMI performance.

In 2015, for performance in non-ST-elevation MI, Einstein reached 88.3%. The difference is primarily due to cardiac rehabilitation referral. Actions to improve this indicator are already underway.

PERFORMANCE IN CARE OF STEMI (ST-ELEVATION MI)

PERFORMANCE IN CARE OF NSTEMI (NON-ST-ELEVATION MI)

It includes the same indicators of overall performance, but analyzes only the data comprising patients

with ST-elevation MI.

It includes five quality indicators, depending on patient eligibility: AAS at arrival and discharge; beta-

blockers at discharge; statin at discharge; ACEI/ ARB at discharge; assessment of cardiac function;

smoke cessation education, and cardiac rehabilitation referral.

95.3 93.3 96.6

0

20

40

60

80

100%

Einstein 2014 Einstein 2015 RegistryACTION 2015

95.388.3

94.1

0

20

40

60

80

100%

Einstein 2014 Einstein 2015 RegistryACTION 2015

24

It includes five quality indicators, depending on patient eligibility: AAS at arrival, assessment of

heart function; reperfusion therapy, fibrinolysis time or door-to-balloon time.

It includes six quality indicators, depending on patient eligibility: AAS at arrival; beta-blockers at

discharge; statin at discharge; ACEI/ ARB at discharge; smoke cessation education, and cardiac

rehabilitation referral.

In 2015, during hospital stay of patients with AMI, Einstein reached 98.4% compliance.

In 2015, at discharge of the patient with AMI, Einstein reached 86.0% compliance.The observed difference is primarily due to education about cardiac rehabilitation. Actions to improve this indicator are already underway.

INTRA-HOSPITAL PERFORMANCE FOR AMI

PERFORMANCE AT DISCHARGE OF PATIENTS WITH AMI

98.0 98.4 97.4

0

20

40

60

80

100%

Einstein 2014 Einstein 2015 RegistryACTION 2015

93.3 86.0 94.0

0

20

40

60

80

100%

Einstein 2014 Einstein 2015 RegistryACTION 2015

25

This indicator measures the time between the arrival of the AMI patient in the Emergency

Department and the opening of the infarction artery in the Cath Lab. The progressive reduction of

the hospital goal and the redesign of actions based on data presented by the ACTION Registry have

resulted in significant reduction in door-to-balloon time.

The median time between arrival at the Emergency Department and performance of angioplasty to unblock the occluded artery was 57 minutes.

In 2015, the survival (adjusted by severity) after AMI was 97.1% at Einstein.

DOOR-TO-BALLOON TIME

SURVIVAL AFTER AMI

56.0 57.0 56.0

0

15

30

45

60

75

90 minuts

Einstein 2014 Einstein 2015 RegistryACTION 2015

96.7 97.1 96.1

0

20

40

60

80

100%

Einstein 2014 Einstein 2015 RegistryACTION 2015

26

HEART FAILURE (HF)

In 2015, 412 patients were admitted into the hospital with main diagnosis of HF. Out of the total, 88%

(363 patients) had systolic HF.

The indicators used to assess the quality of care were: prescription of medications that improve the

clinical progression of the patients (ACEI/ ARB and beta-blockers), assessment of cardiac function,

education about the disease before discharge and hospital mortality rate.

Prescription of ACEI/ ARB at hospital discharge occurred in 100% of eligible patients.

Prescription of beta-blockers at hospital discharge occurred in 99.6% of eligible patients.

PRESCRIPTION OF ACEI/ARB AT HOSPITAL DISCHARGE

PRESCRIPTION OF BETA-BLOCKER AT DISCHARGE

98.0 100.0

32.7

0

20

40

60

80

100%

Einstein 2014 Einstein 2015 ANAHP 2015

98.6 99.6

41.0

0

20

40

60

80

100%

Einstein 2014 Einstein 2015 ANAHP 2015

27

In 2015, the compliance rate of cardiac function assessment (using imaging) during hospital stay was 100%.

Einstein reached unexpected readmission rate within 30 days of 14.9% in 2015.

ASSESSMENT OF CARDIAC FUNCTION DURING HOSPITAL STAY

UNEXPECTED READMISSION RATE WITHIN 30 DAYS

100.0 100.0 99.0*

0

20

40

60

80

100%

Einstein 2014 Einstein 2015 Hospital Comparison 2015

* For further information, click here

* For further information, click here

14.922.0*

0

20

40

60

80

100%

Einstein 2015 Hospital Comparison 2015

28

In 2015, the rate of non-obstructive coronary disease in cardiac catheterization was 22%.

98% of the percutaneous coronary interventions were successful in 2015.

RATE OF NON-OBSTRUCTIVE CORONARY DISEASE IN CARDIAC CATHETERIZATION

SUCCESS RATE OF PERCUTANEOUS CORONARY INTERVENTIONS

PERCUTANEOUS CORONARY INTERVENTION

In 2015, the hospital performed 876 cardiac catheterizations and 517 percutaneous

coronary interventions (PCI). Check below the main indicators referring to

percutaneous treatment of coronary artery disease.

23 22

39

0

10

20

30

40

50%

Einstein 2014 Einstein 2015 CathPCI ACC-NCDR 2015

98 98

0

20

40

60

80

100%

Einstein 2014 (N=492)

Einstein 2015 (N=517)

29

2.7 4.20

20

40

60

80

100%

Einstein 2015 CathPCI ACC-NCDR 2015

In 2014 and 2015, the drug-eluting stent was the most frequently used.

The bleeding rate of inpatients after angioplasty was 2.7%, below the rate observed in the North American Registry CathPCI.

The rate of survival of inpatients after angioplasty was 97.8% in 2015, comparable to that of the North American Registry CathPCI.

STENT USE

IN-HOSPITAL SURVIVAL AFTER PCI

IN-HOSPITAL BLEEDING AFTER PCI

8867

226

5 45 3

0

20

40

60

80

100%

Einstein 2014 (n=492) Einstein 2015 (n=517)

Drug-elutingBioabsorbable platform (*)

Balloon angioplastyBare metal stent angioplasty

97.8 98.1

0

20

40

60

80

100%

Einstein 2015 CathPCI ACC-NCDR 2015

*Plataforma bioabsorvível foi aprovada pela Anvisa, para uso clínico, em novembro de 2014.

30

PERCUTANEOUS IMPLANT OF AORTIC VALVE

In 2015, 21 transcatheter aortic valve implantations (TAVI) were performed. Check

below the main indicators referring to the procedure.

The demographics of the patients submitted to transcatheter implant of aortic

bioprostheses between 2008 and 2015 can be seen below.

Patient Characteristics – 2008 to 2015 (n = 138)

Age (years) 82 ± 7.7

Male, n (%) 79 (57.2)

EuroScore, (%) 16.5 ± 11.6

STS Score, (%) 10.3 ± 9.5

NYHA CF III or IV, n (%) 93 (67.4)

Diabetes Mellitus, n (%) 40 (29)

Renal failure*, n (%) 93 (67.4)

Coronary Artery Disease, n (%) 72 (52.2)

Previous AMI, n (%) 17 (12.3)

Previous CHF, n (%) 48 (34.8)

Previous MRI, n (%) 22 (15.9)

Porcelain Aorta, n (%) 6 (4.3)

Previous stroke, n (%) 13 (9.4)

Peripheral Arterial Disease, n (%) 18 (13)

Chronic Obstructive Pulmonary Disease, n (%) 29 (21)

* GFR<60ml/min

31

30-DAY SURVIVAL AFTER TAVI PROCEDURE

TYPE OF AORTIC BIOPROSTHESES

TYPE OF ACCESS ROUTE

In 2015, 30-day survival after percutaneous implant of an aortic valve was 95.2%, above the level of the Brazilian Registry of TAVI.

In 2015, 21 procedures were performed, and Sapiens XT was used in 76.2% of the procedures.

The access route more frequently used in 2015 was transfemoral access (95.2%). Alternative arterial accesses were used in patients with severe peripheral arterial disease.

Pág. 25- G193.8 95.2 90.9 *

0

20

40

60

80

100%

Einstein 2014 Einstein 2015 TAVI BrazilianRegistry

*Catheterization and Cardiovascular Interventions, 2015 85:E153–E162

37.523.8

62.5 76.2

0

20

40

60

80

100%

TAVI 2014 (N=32) TAVI 2015 (N=21)CoreValve Sapiens XT

93.8 95.2

6.2 4.8

0

20

40

60

80

100%

TAVI 2014 (N=32) TAVI 2015 (N=21)

Trans Femoral Trans Arterial

32

NEED FOR DEFINITE PACEMAKER AFTER PROCEDURE *

In 2015 there was significant reduction of the need to implant a definitive pacemaker after TAVI procedure, which occurred in 5% of the cases. It explains the technology development associated with the experience of the hospital with the procedure.

*excluding patients with previous permanent pacemaker and/or ICD and death during the procedure.

29.6

5.00

20

40

60

80

100%

TAVI 2014 (N=32) TAVI 2015 (N=21)

MITRACLIP®

The first mitral valve repair procedure with Mitraclip® occurred in January 2015. Until

December, there were eight procedures in patients aged on average 82.8 years, 50% of

whom were women. The mean length of stay after the procedure was 5.6 days.

33

ROBOTIC CARDIAC SURGERY

From March 2010 to December 2015, 45 fully robotic cardiac surgery procedures

were performed in 39 patients using Da Vinci robotic system. Patients’ ages ranged

from 18 to 81 years (mean age 51 ± 17.9 years) and most patients were male

(69.2%).

The most frequent indications were mitral valve insufficiency, atrial septal defect

and myocardial revascularization, which represented 79% of the cases.

PREOPERATIVE DIAGNOSIS

Mitral Regurgitation(N=18)

Atrial Septal Defect (N=7)

Heart Failure (N=6)

Heart Tumor(N=4)

Mitral regurgitation and Stenosis (N=2)

Pericarditis (N=1)

Atrial Fibrillation(N=1)

46%

3%3%

5%10%

15%

18%

34

LENGTH OF HOSPITAL STAY

The mean length of hospital stay was 6.7 days and the ICU stay was 2.5 days.

PERFORMED SURGICAL PROCEDURE

Mitral valve surgeries (repair and replacement), atrioseptoplasty, heart tumor resection and

closure of patent foramen ovale (PFO) amounted to 84% of the procedures.

TOTAL LENGTH OF HOSPITAL STAY

64.1% of the patients remained up to five days in the hospital.

0.0

12.8

51.3

35.9

0

20

40

60

80

100%

0 a 1 day(N=0)

2 a 3 days (N=5)

4 a 5 days (N=20)

> 5 days (N=14)

Mitral valverepair (N=15)

Atrioseptoplasty(N=7)

Myocardial Revascularization

(N=6)

Mitral valve Replacement (N=5)

Ressection of Intra-cardiac tumors (N=4)

Hybrid therapy for atrial �brillation (N=1)

Pericarditis(N=1)

38%

3%3%

10%

13%

15%

18%

35

LENGTH OF STAY IN THE ICU

Approximately half of the patients remained only one day in the UCI after a robotic cardiac surgery.

53.8

33.4

5.1 7.7

0

20

40

60

80

100%

0 a 1 day(N=21)

2 a 3 days (N=13)

4 a 5 days (N=2)

> 5 days (N=3)

SURVIVAL OF PATIENTS SUBMITTED TO ROBOTIC SURGERY

The survival during the follow-up period after discharge was 95%. The mean follow-up time was 37.5

months (3.12 years). There was no patient lost to follow-up.

95%

Kaplan-Meier Survival Curve – Robotic Surgery 2010-2015

Patient Follow-up (months)

Like

lihood o

f Su

rviv

al %

36

FUNCTIONAL IMPROVEMENT

After 5.8 years of follow-up, 100% of the patients were Functional Class I of New

York Heart Association (NYHA), that is, no evidence of cardiovascular symptoms for

everyday activities.

25.8%

84.6%

43.5%

15.4%

30.7%

0%0% 0%Preoperative Postoperative

I II III IV

Functional classification of New York Heart Association (NYHA)

Functional Class 1 – Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea or

angina.

Functional Class 2 – Ordinary physical activity results in fatigue, palpitation, dyspnea or angina and

patient is more comfortable at rest.

Functional Class 3 - Patient feels more comfortable at rest and has marked limitation in activity due to

symptoms.

Functional Class 4 – Unable to carry out any daily activity, presenting fatigue, dyspnea, palpitation and

angina at rest and any physical activity causes distress.

37

HEART TRANSPLANT

RANKING OF HEART TRANSPLANTS – BRAZILBRAZILIAN REGISTRY OF TRANSPLANTS 2015

Hospital Sirio-Libanês (SP)

Soc. Hospitalar Angelina Caron (PR)

Instituto do Coração - Pernambuco (PE)

Sta Casa de Curitiba (PR)

Instituto Dante Pazzanese Cardiologia (SP)

Hospital de Messejana (CE)

Instituto de Cardiologia do DF (DF)

Hospital Israelita Albert Einstein (SP)

IMIP - Inst. Medicina Integral (PE)

HC - UFMG (MG)

Instituto do Coração - FMUSP (SP)

2014 2015

68

59

32

32

16

31

17

30

25

30

22

23

22

23

14

20

9

15

11

12

9

4

In 2015, 30 heart transplants were performed at Einstein. There was 43.3% increase compared to 2014

38

Patient Experience

“Having an ischemic myocardiopathy, I felt very weak when I was admitted at Einstein for a heart transplant. I could not walk 100 meters.

I waited 60 days for the organ to arrive. When I woke up from the surgery, the first sensation I had was that I could start running. It is as if I had been born again. I had an excellent recovery. Even the physicians were impressed. Within 24 hours I was extubated and 48 hours later I was sitting down. Get out of bed, walk, take my first beverage, eat a feijoada, climb upstairs… each activity after surgery was felt as if it were the first time. I was discharged 50 days after surgery and no sooner could I resume my activities. From the hospital stay, I recall the good infrastructure of the hospital, the humanized care of the teams, and the good food."

Hugo César Teixeira Arruda, 34-year-old businessman, Lages (SC)

39

RANKING OF HEART TRANSPLANTS – STATE OF SAO PAULO REGISTRY OF TRANSPLANTS 2015

Hospital Unimed Sorocaba

Hospital dos Fornecedores de Cana(Piracicaba)

FAMERP - FUNFARME – Hosp. Base

UNIFESP - Hospital São Paulo

Hospital Sirio-Libanês

Hospital do Coração

Universidade Estadual de Campinas

Hospital Bene�cência Portuguesa

Instituto Dante Pazzanese Cardiologia

Hospital Israelita Albert Einstein

Instituto do Coração - FMUSP

2014 2015

49

17

30

19

23

8

9

11

6

2

5

3

4

0

0

00

4

2

1

3

59

In 2015, Einstein ranked second as heart transplant center in the state of Sao Paulo.

40

“Since the day I was taken to an ICU in 2007 due to a severe heart failure, I had been to different hospitals until I got to Einstein, where I was admitted for heart transplant in 2015. I was there 129 days, 87 of them waiting for a new organ.

It was a tense and anxious period. To spend my time, I used to take pictures of all of those who came into the room. My children printed and placed them on a wall poster. I have also created a character, Coracaozinho Maluco (Crazy Little Heart), writing stories that were posted in Facebook. Despite the touchy moment, the environment at Einstein helped me keep up. I could even get a visit from my two dogs! Even so, there were moments in which I felt like giving up. However, thanks to my faith in God, the love of my wife, children, family members and friends and the support of the entire team at Einstein, I managed to overcome all the stages. After so much time lying down on a bed, I had to take physical therapy sessions to relearn how to walk. Now, everything is fine. I was discharged in January and in March I was back to work again.”

José Santiago da Luz, 56-year-old auditor, São Paulo (SP)

Patient Experience

41

ONE-YEAR SURVIVAL AT HOSPITAL ISRAELITA ALBERT EINSTEIN

(N = 56)

SURVIVAL OF TRANSPLANTED PATIENTS

The one-year survival of transplanted patients at Einstein between 2014 and 2015

was 84.8% and the 10-year survival was 70.2%.

84.8%

HEALTH DEPARTMENT OF STATE OF SAO PAULO

STATE TRANSPLANT SYSTEM

Actuarial Survival Report – Kaplan-Meier

Years

Organ: Heart. Event: Patient; Period: 1/Jun/2002 to 25/May/2016; Review Date: 25/May/2016; Team: Albert Einstein – Fernando Bacal; Donor Age: 0 to 100 years; Sodium: 100 to 200; Recipient Age: 0 to 100 years; Interval: 365 days; N=56 (Survival = 84.81%)

42

1 year = 63.4%3 years = 58.2%5 years = 54.5%10 years = 45.2%15 years = 43.2%

SURVIVAL RATE IN THE STATE OF SAO PAULO (N=1,269)

3 years = 75.9%5 years = 68.3%8 years = 68.3%9 years = 70.8%

3, 5, 8 AND 9-YEAR SURVIVAL RATES AT HOSPITAL ISRAELITA ALBERT EINSTEIN (N=29)

HEALTH DEPARTMENT OF STATE OF SAO PAULOSTATE TRANSPLANT SYSTEM

Actuarial Survival Report – Kaplan-Meier

Years

Organ: Heart. Event: Patient; Period: 1/Jan/2002 to 25/May/2016; Review Date: 25/May/2016; Team: Albert Einstein – Fabio Jatene; Donor Age: 0 to 100 years; Sodium: 100 to 200; Recipient Age: 0 to 100 years; Interval: 365 days; N=29 (Survival = 70.8%)

HEALTH DEPARTMENT OF STATE OF SAO PAULOSTATE TRANSPLANT SYSTEM

Actuarial Survival Report – Kaplan-Meier

Years

Organ: Heart. Event: Patient; Period: 1/Jan/2002 to 25/May/2016; Review Date: 25/May/2016; Location: State of Sao Paulo; Donor Age: 0 to 100 years; Sodium: 100 to 200; Recipient Age: 0 to 100 years; Interval: 365 days; N=1,269 (Survival = 42.08%)

43

CODE BLUE

Code Blue comprises the set-up of routines for providing care to adult patients (≥ 18 years)

who have suspicion of a cardiac arrest.

The Code Blue team is formed by two cardiologists, one nurse and two respiratory therapists.

In 2015, there were 24 Code Blue events. The interval between admission into the hospital and

Code Blue call was 15 days on average (median = 6 days).

Concerning the type of cardiac arrest, 63% of the patients presented pulseless electrical activity,

21% had asystole, and 4% had ventricular fibrillation/ tachycardia.

DISTRIBUTION BY UNIT THAT CALLED THE CODE

PERFORMANCE OF CODE BLUE TEAM CARE

28

47

7

16

2

3429

25

84

0

10

20

30

40

50 calls

Clinical and surgical care Operating Unit Diagnostic Medicine Cardiovascular Intervention Center

Dialysis Center

2014 (N=43) 2015 (N=24)

100 96100 100

0

20

40

60

80

100%

2014 (N=43) 2015 (n=24)

Interval rate between the arrest and the arrival of the Code Blue Team within 3 minutes.

Rate of beginning of chest compressions before the arrival of the Code Blue Team.

In 2015, the performance of the team was 100%.

44

BEGINNING OF HYPOTHERMIA WITHIN 6 HOURS AFTER SPONTANEOUS CIRCULATION IS RESTORED (PATIENTS IN COMA)

Therapeutic hypothermia is indicated in patients who remain in coma after the resume of

spontaneous circulation. The goal is to have a controlled reduction of central temperature

focusing on minimizing the neurological damage caused by cardiac arrest. In 2015, 100% of

the eligible patients for hypothermia started the protocol within six hours after spontaneous

circulation return.

RESUME OF SPONTANEOUS CIRCULATION RETURN AFTER ARREST

HOSPITAL DISCHARGE AFTER CARDIAC ARREST

In 2015, spontaneous circulation return after a cardiac arrest was 50%.

In 2015, 29% of the patients who had a cardiac arrest event were discharged from hospital.

5650

45

0

20

40

60

80

100%

2014 (N=17/25)

2015 (N=24/43)

National Cardiac ArrestAudit (NCAA)

* Created in November 2008 by the Resuscitation Council (UK) and the Intensive Care National Audit and Research Centre, it started to collect data in October 2009. Until January 2013, it had records of cardiac arrests that had occurred in 8,865 patients of 150 hospitals in the United Kingdom and Ireland. REF: Goldberger ZD, Nichol G. Registries to measure and improve outcomes after cardiac arrest. CurrOpinCritCare 2013; 19(3):208-13.

2329

19

0

20

40

60

80

100%

2014 (N=10/43) 2015 (N=7/24) National Cardiac Arrest Audit (NCAA)

45

Patient ExperienceIn the pursuit of excellence in care, knowing how to listen to patients is a differential we have at Einstein: Surveys are constantly carried out to indicate how the cardiac inpatients are experiencing the care they receive.

“In 2015 when the tests indicated I need a myocardial revascularization surgery, I started to look for physicians and hospitals. It was a very distressing time. I was the same age as my father when he passed away while performing the same procedure I was going to undergo. I talked to physicians, I visited hospitals in Belem (PA), I heard the opinion of different people… but all the time I kept remembering my father´s death. Through a friend, I got good recommendation of Einstein and decided to come. I can tell you it was the most important decision I´ve made in my life. Even before I travelled to Sao Paulo a physician had contacted me to learn about the tests I had undergone and the medication I was taking. When I arrived, he took me in a tour of the catheterization center and the ICU at Einstein I was amazed! On that day, after a week, I could finally eat and sleep. I got into the operating room on Monday, on Tuesday I was sitting down and on Wednesday I was walking around the room… I was discharged on Friday and, as I wanted, I could spend Sunday with my family celebrating Father's Day in a restaurant in Sao Paulo. Forty-five days later I was back to riding my bike.”

Fabio Gilson Souza Bezerra, 53-year-old business man, Castanhal (PA)

46

SATISFACTION SURVEY OF INPATIENTS WITH CARDIAC DISEASE

SATISFACTION OF INPATIENTS WITH ACUTE MYOCARDIAL INFARCTION

In a scale from 1 (very bad) to 5 (excellent) how do you score your hospital stay?

In 2015, 89% of the inpatients with cardiac disease who answered the survey stated they were satisfied with the care.

Concerning AMI inpatients, 93% stated they were satisfied with care in 2015.

SATISFACTION RATE

0 05 9

86

0 2 413

80

0

20

40

60

80

100%

1 2 3 4 5

2014 (N=21) 2015 (N=157)

80828486889092949698100%

2012 2013 2014 2015

90

88 88 89

47

Teaching and Scientific Events

To disseminate knowledge in the area of Cardiologyto the benefit of society, Einstein developed in 2015many high-level courses and scientific events directed to students, resident physicians, clinical staff and the national and international medical community.

48

Medical Residency

The Medical Residency Program in Cardiology is characterized by major involvement of the

faculty with the students by means of weekly clinical meetings, case discussions, critical analyses

of scientific papers and incentive to clinical and basic research. Technological innovations in

Cardiology are constant and the opportunity to experience situations and use the latest generation

equipment provides to Einstein resident physicians a comprehensive training that prepares them to

start daily clinical practice. In addition to the hospital infrastructure, the residency program counts

on the support of the training centers, Realistic Simulation Center and Instituto Israelita de Ensino e

Pesquisa.

In 2015, the program had three first-year and three second-year resident physicians. To learn more,

click here.

Graduate Studies

In addition to non-degree graduate courses in Cardiology, as of 2014, the degree graduate course

started to provide medical sciences research opportunities for research lines and projects in basic,

physiological and pathophysiological studies or those related with diagnostic aspects, treatment

and prevention of communicable and non-communicable diseases. In Cardiology, the research line is

Aging and it has 15 advisors, out of which eight are cardiologists.

Non-Degree Graduate Studies

In 2015, the non-degree graduate courses were expanded to Teaching Unit in Rio de Janeiro - RJ.

The following courses were provided: Cardiology for Physicians, Nursing Cardiology and Cath Lab,

and Adult Intensive Care Therapy: Intensive Therapy in Cardiothoracic Medicine.

For additional information, click here.

Degree Graduate Studies

• Master‘s Degree in Health Sciences

• Doctorate in Health Sciences

For additional information, click here.

49

Improvement Programs

Directed to physicians who complete the residency program and wish to get specialized in specific

areas of knowledge.

For additional information, click here.

Programs available:

• Improvement in Electrophysiological Methods in Cardiology

• Improvement in Transplant and Heart Failure to Clinicians

• Improvement in Heart Transplant and Mechanical Circulatory Support – Surgical Area

• Improvement in Vascular Radiology

• Course of Imaging-Guided Interventional Medicine in Gynecology and Obstetrics.

In Company courses

The organizations that hire the courses define the availability of time of the staff, the training

schedule and the format (face-to-face or distance learning). The course program may be applied in

its original format or customized and it may include hands-on training programs in the Training and

Surgical Experimental Center and/or scenarios in the Realistic Simulation Center. In 2015, three in

company courses were offered in Cardiology:

• Stroke prevention in patients with atrial fibrillation using realistic simulation

• Advanced training in AF with realistic simulation

• Heart failure.

50

Refresher Courses

The courses provide immersion in specific areas of knowledge and are directed to physicians and

the multiprofessional team. To learn more, click here.

• Nursing Care in Diagnostic Cardiology Unit

• Cardiac Arrhythmia for Office Care

• Physical Activity for Healthy Aging

• Role of the Psychologist in Cardiology

• Intra-Aortic Balloon

• Sport Cardiology: The Care of Athletes in

Medical Offices

• Intensive Cardiology

• Endovascular Surgery

• Circulatory Support Devices to Nurses

• Valve Disease and Endocarditis to Clinicians and

Cardiologists

• Hemodynamic Echocardiography for

Pediatricians

• 3D Echocardiography in the 21st Century

• Permanent Education in Cardiology

• Basic Electrocardiogram for Nurses

• Advanced Electrocardiogram for Nurses

• Electrocardiogram for Clinicians and Medical

Students

• Electrocardiogram for Physical Therapists

• Cardiologic Emergencies for Clinicians

• Pharmacology Applied to Cardiovascular

Medication used in the ICU

• Clinical Physiology of Exercise: Prescription of

Aerobic Exercises in Chronic Diseases

• Cardiovascular and Respiratory Physiology

• Physical Therapy: Evidence-Based

Neuromuscular Electrical Stimulation in

Cardiopathy Patients

• Skills in the Trauma Room with Realistic

Simulation

• Immersion in Cardiology

• Immersion in Nursing Care in the Cath Lab

• Immersion in Imaging Diagnosis for Physicians

– Thoracic and Cardiovascular

• Heart failure

• Office Care – Cardiology and Endocrinology

• Course of Imaging-Guided Interventional

Medicine in Gynecology and Obstetrics

• Scientific Methodology and Applied Statistics

• Diagnostic Method in Cardiology for Clinicians:

What is it and who should I order it to?

• Nutrition Applied to Exercise: Theory and

practice.

• Pilates to Cardiac Patients

• Postoperative Care of Cardiac Surgeries

• Cardiac Rehabilitation to Physical Therapists:

Hospital Stage

• Outpatient Cardiopulmonary Rehabilitation

• Cardiovascular Rehabilitation to Physical

Educators

• Acute Coronary Syndromes

• Optical Coherence Tomography and

Intravascular Ultrasound

• Basic Urgencies and Emergencies with Realistic

Simulation

• Clinical Urgencies and Emergencies in the

Emergency Department

• Pediatric Urgencies in SUS – Cardiology and

Neurology

51

Distance Learning

Distance learning is a modality that enables the student to invest in his career and build up a new

knowledge basis using technologies and collaborating with other professionals, no matter where

they are. To learn more, click here.

• Chest Pain Approach in Emergency Department

• Physical Therapy Care in Patients with Decompensated Heart Failure

• Electrocardiogram for Nurses

• Clinical Examination and Management of Valve Diseases.

Hospital training in cardiovascular urgencies and emergencies in the Realistic Simulation Center

Directed to professionals hired by Einstein (physicians, nurses and physical therapists), it intends

to provide the qualification for initial and advanced care in situations of emergencies, as defined by

the policy: Qualification of the team at Sociedade Beneficente Israelita Brasileira Albert Einstein to

provide care in situations of emergency.

Cardiology Forum

Created to discuss institutional protocols and issues that impact the practice in the organization,

forums take place every first Friday of the month, from 12h30 to 1h30 pm at Centro de Educacao

em Saude Abram Szajman (CESAS), organized by the Clinical Director and the Cardiology Program.

Scientific Meetings

These meetings bring together physicians and multiprofessional teams to discuss relevant topics

and clinical case reports of the specialty.

Cardiology Scientific Meeting

It takes place periodically every Last Friday of the month from 12 to 2pm at Centro de Educacao

em Saude Abram Szajman (CESAS), with live web transmission. It is organized by the Cardiology

Clinical Staff, together with the Cardiology Program.

52

Case Review Session with Fellows – Interventional & Clinical Cardiology

On the second Thursday of each month, from 12 to 1 pm. at Centro de Educacao em Saude Abram

Szajman (CESAS). Organized by the Cardiovascular Intervention Center and NAEC (Cardiology

Teaching Support Center), it comprises case studies and discussions held in English.

Interventional Cardiology Scientific Meeting

On the last Thursday of each month, from 12 to 1 pm. at Centro de Educacao em Saude Abram

Szajman (CESAS). They are organized by the Cardiovascular Intervention Center.

Scientific Meetings of Interventional Vascular Radiology, Vascular Surgery and Imaging

They take place every Tuesday from 7:30 to 8:30 am at Centro de Educacao em Saude Abram

Szajman (CESAS). They are organized by the Interventional Vascular Radiology directed to the

multiprofessional team.

Echocardiography Scientific Meeting

In 2015, there were three meetings in virtual format using webcasting.

Symposia

In 2015, there were two symposia in Cardiology:

• 8o Simpósio Satélite da Cardiologia Einstein no XXXVI Congresso da Sociedade de Cardiologia

do Estado de São Paulo (8th Satellite Symposium of Einstein Cardiology at Congress of the

Cardiology Society of the state of Sao Paulo), on June 6, 2015. Topic: “Cardiology frontier:

Bioabsorbable stents in acute coronary syndrome and ventricular assist devices in advanced

heart failure”.

• Einstein Cardiology Symposium: Innovation and Update in Clinical Practice. Held at Auditorium

Moise Safra, Einstein, on December 5, 2015, gathering 364 participants. The main goal was

to discuss from an open, updated and practical standpoint the key advances in different areas

of Cardiology with the expertise of Einstein Medical Staff, in order to improve daily clinical

practice.

53

Research and Scientific Production In 2015, the area of cardiovascular research at Einstein presented a high number of publications in scientific journals with impact factor > 1, in addition to the significant increase in number of projects either submitted or ongoing.

54

Research and Scientific Production

Research Lines

The research lines provide the integration between independent physicians of the medical staff and hired

physicians with the multiprofessional team, based on the common theme of Aging. The main research

line to highlight is Behavioral Cardiology, which represents a new frontier to Cardiology. It encompasses

the study of the association between mental and cardiovascular health, the relation between psychosocial

risk factors (stress, income, work, family relationships) and the incidence of cardiovascular diseases and,

finally, the study of human behavior and the mechanisms that rule treatment compliance by patients. The

research lines in 2015, under the coordination of NAPEC (Cardiovascular Research Support Center) are

represented in the figure below.

AGING

Behavioral Cardiology

Atherosclerosis / Vascular calcification

Arrhytmiacardiac

Cardio-oncology

Exercise Cardiology

Cardiovascularprevention

Heart Failure

Economics Analyses in Cardiology

Cardiovascularinterventions

Peripheral vasculardisease

55

Publication in scientific journals

In 2015, a total of 53 studies were published in the cardiovascular area, 41 of them in scientific journals

with impact factor > 1. The goal defined for 2015 was to reach 30 publications with IF > 1. The complete

list with the publications from 2015 can be accessed – click here.

917

2536 41

8

21

28

3112

0

20

40

60

80 studies

2011 (N=17)

2012 (N=38)

2013 (N=53)

2014 (N=67)

2015 (N=53)

Impact factor >1 Impact factor <1

DISTRIBUTION OF PUBLICATIONS BY SECTORS (2014-2015)

2010 8

20

510 1 2 1

19

17

6

4

32

1 1

CardiovascularIntervection

NAPEC Check-up Vascular Medical Sta� Echocardio-graphy

Severe-ill patients

Exercise Cardiology

Arrhythmia Center

CardiacSurgery

2014 2015

56

PRESENTATION OF PAPERS IN CONGRESSES

DISTRIBUTION BY SCIENTIFIC EVENT

4352

25

2721

20

2013 (N=70) 2014 (N=73) 2015 (N=45)

National International

1

1

2

3

2

5

4

10

16

0

0

0

0

2

0

3

1

28

EPI/Lifestyle

International Society of Atherosclerosis

Congresso Brasileiro de Arritmias Cardíacas

American Heart ATVB

Congresso Brasileiro de Cirurgia Vascular

European Society of Cardiology

Cardiovascular da SBC

Cardiovascular and Interventional

Radiological Society of Europe

Congresso Departamento de Imagem

American College of Cardiology

2014 2015

57

Scientific projects which have been submitted or are ongoing

The number of submitted or ongoing projects in the Research project management system (SGPP –

Sistema de gestao de projetos de pesquisa) increased 37% in 2015.

Participation in the clinical operation of the Studies

In 2015, NAPEC conducted the clinical operation of the following studies, with the respective number of

included patients:

• Study PODAC (Proteinas Osteogenicas da Doenca Arterial Coronaria – Osteogenic Proteins of Coronary

Artery Disease): 101 patients included

• Study Chagasics (Ensaio Clinico Randomizado de Prevencao Primaria de Morte na Cardiopatia

Chagasica Cronica: Uso de Amiodarona versus Cardio desfribrilador Implantavel - Randomized Clinical

Trial of Primary Prevention of Death in Chronic Chagas Cardiopathy: Use of Amiodarone versus

Implantable Cardioversor Defibrillator): 24 patients included

• Cryoablation Study (Comparacao da Crioablacao Utilizando Balao com a Ablacao por Radiofrequencia

no Tratamento da Fibrilacao Atrial Paroxistica – Comparison of Cryoablation Using Balloon with

Radiofrequency Ablation in Treating Paroxysmal Atrial Fibrillation): 4 patients included.

2211 6 1

34

16

12

1

ClinicalCardiology

(N=56)

Vascular Surgery(N=27)

Interventional Cardiology

(N=18)

Cardiovascular Surgery(N=2)

2014 2015

58

Social responsibility

Philanthropy is constantly present at Einstein’s activities: from PROADI-SUS Institutional Development Support Program of SUS – Programa de Apoio Ao Desenvolvimento Institucional) initiatives, such as Heart transplants and Telemedicine Unit, to the outpatient center at Vila Mariana directed to the care of patients from low-income communities.

59

Heart Transplant

Out of 30 heart transplants performed in 2015, 25 were philanthropic, as part of the Transplant

Program funded by Instituto Israelita de Responsabilidade Social, partnering with the Project Apoio ao

Desenvolvimento Institucional do Saude (PROADI-SUS). Additional data about the clinical progression

of the transplanted patients may be seen in the chapter that addresses quality and clinical outcomes.

Cardiology Medical Residency Outpatient Center

The Cardiology Medical Residency Outpatient center operated from Unit Vila Mariana in 2015, funded

by Instituto Israelita de Responsabilidade Social, serving the patients in the Jewish community

through Program Einstein na Comunidade Judaica (PECJ).

Telemedicine

Project Aplicacao da Telemedicina no Apoio Diagnostico e Terapeutico ao Doente Grave nas

Emergencias (Application of Telemedicine in Supporting Diagnosis and Management of Severe

Diseases in Emergencies), part of PROADI-SUS program, started in 2012. Einstein Telemedicine Center

receives calls from participating hospitals, connected 24 by 7.

60

Brand Dissemination and ManagementCardiology website has been the most accessed of Einstein, showing increase in number of visitors. More than a hundred mentions in the media have also reinforced the interest and the importance of the specialty.

61

Institutional website

Number of visits

Cardiology was the most accessed specialty in the website in 2015. There was 20.2% increase in number

of visits, 21.9% in number of new visitors and 24.2% in number of page visualizations in comparison

with 2014.

Media Participation

In 2015, there were 124 articles in the media (printed, radio and TV) making reference to

Einstein Cardiology.

851,016

646,999

1,111,7791,056,575

788,566

1,336,508

0

400,000

800,000

1,200,000

1,600,000

Number ofVisits

Number of new visitors

Number of page

visualizations2014 2015

HOME PAGE CARDIOLOGY

Marketing Actions

In 2015 the marketing actions involved these key topics:

• 8º Simposio Satelite da Cardiologia Einstein no XXXVI Congresso da SOCESP (June 6, 2015), at Transamerica

Expo Center: Presentation of a high complexity topic (bioabsorbable stents in acute coronary syndrome and

ventricular assist devices in advanced heart failure), gathering 570 congress attendees.

62

• Communication about Pediatric Cryoablation to a strategic audience presenting a vanguard technique

of Einstein Cardiology, reinforcing the specialty as a reference in pediatric cardiology.

• Dissemination of the acknowledgment by

American College of Cardiology: Platinum

Performance Achievement Award, received

by Einstein Cardiology, Reinforcing the

specialty as an international reference

in providing high complexity care and

treatment (especially to AMI patients)

CARDIOLOGIA EINSTEINé reconhecida

internacionalmente

O Einstein recebeu o Platinum Performance Achievement

Award, mais um reconhecimento do American College of

Cardiology, desta vez sobre o nosso desempenho

positivo no tratamento de pacientes com Infarto

Agudo do Miocárdio, que se manteve acima de 90%

por oito trimestres consecutivos.

63

Staff & Contact Information

64

EINSTEIN CARDIOLOGY PROGRAMPHONE: (55 11) 2151-1140

Dr. Marcelo Franken Medical Manager marcelo.franken@einstein.br

Dr Patrícia Villodre Alliegropatricia.alliegro@einstein.br

Elaine Rodrigues Brito Administrative Support rodrigues.elaine@einstein.br

Paula Kiyomi Onaga Yokota Senior Nurse paula.yokota@einstein.br

Tarsila Perez MotaJunior Nurse tarsila.mota@einstein.br

Adriano Alves LeiteHybrid Nurse – CMC adriano.leite@einstein.br

Leandro Loureiro BuzattoHybrid Nurse Coronary Unit leandro.buzatto@einstein.br

ARRHYTHMIA CENTER(55 11) 2151-9410

Dr. Guilherme Fenelon CostaTechnical-Scientific Leader guilherme.costa@einstein.br

RN Elisabete Barbosa GuedesCoordinating Nurse elisabete.guedes@einstein.br

SPORT AND EXERCISE CARDIOLOGY

Dr. Leandro Echenique Sport Cardiologist leandro.echenique@einstein.br

Dr Luciana D. N. Janot de MatosSport and Rehabilitation Center Cardiolo-gistluciana.matos@einstein.br

CARDIOPULMONARY DIAGNOSTIC CENTER(55 11) 2151-9855

Dr. Samira Morhy Medical Managersamira.m@einstein.br

Dr. Claudio Fischer Medical Coordinator of the Echocardiogra-phy Sector claudio.fischer@einstein.br

Dr. Romeu MenegheloMedical Coordinator of Graphic MethodsRomeu.meneghelo@einstein.br

Carla Manuela Pereira de Araújo Coor-dinating Nurse carla.araujo@einstein.br

CARDIOVASCULAR INTERVENTION CENTER(55 11) 21510434

Dr. Adriano CaixetaInterventional Cardiologist adriano.caixeta@einstein.br

Dr. Alexandre AbizaidInterventional Cardiologist alexandre.abizaid@einstein.br

65

Dr. Breno Oliveira Almeida Interventional Cardiologist breno.almeida@einstein.br

Dr. Carlos de Magalhães Campos Interventional Cardiologist carlos.magalhaes@einstein.br

Dr. Fabio Sandoli de Brito Jr Interventional Cardiologist fabio.brito@einstein.br

Dr. Felipe NasserInterventional Vascular Radiologist felipe.nasser@einstein.br

Dr. Breno Boueri Affonso Interventional Vascular Radiologist breno.affonso@einstein.br

Dr. Francisco Leonardo Galastri Interventional Vascular Radiologist francisco.galastri2@einstein.br

RN Ivanise Gomes Amorim Coordinating Nurse ivanise.gomes@einstein.br

PREVENTIVE MEDICINE CENTERCheckup Unit(55 11) 2151-6293

Dr Raquel D. de O. ConceiçãoMedical Manager raquel.conceicao@einstein.br

Dr. Viviane Arevalo Tabone Medical Coordinator of Checkup Unitviviane.tabone@einstein.br

Dr. Raul Dias dos Santos FilhoCardiologist, Consultant of Cardiovascular Checkupraul.filho@einstein.br

INSTITUTIONAL CARDIAC SURGERY(55 11) 2151-9410

Dr. Robinson Poffo Coordinator robinson.poffo@einstein.br

SUPPORT GROUP IN CARDIOLOGYDr. Antonio Eduardo Pereira Pesaro Coordinator antonio.pesaro@einstein.br

CARDIOLOGY IMAGING(55 11) 2151-9833

Dr. Cesar Higa NomuraCoordinator of CT and MRI cesar.nomura@einstein.br

Dr. Jairo Wagner Coordinator of Nuclear Medicin jairo.wagner@einstein.br

CARDIOVASCULAR RESEARCH SUPPORT CENTER (NAPEC)(55 11) 2151-9408

Dr. Marcelo Katz Coordinator mkatz@einstein.br

RN. Carolina PereiraResearch Coordinating Nurse carolina.pereira2@einstein.br

RN. Teresa Cristina Nascimento Coordinator of Clinical and Scientific Information teresa.nascimento@einstein.br

66

CARDIOLOGY TEACHING SUPPORT CENTER(55 11) 2151-9410

Dr. Antonio Carlos Bacelar Nunes FilhoCoordinator antonio.filho@einstein.br

HEART TRANSPLANTDr. Fernando BacalCoordinator of Clinical Team fernando.bacal@einstein.br

Dr. Robinson PoffoCoordinator of Surgical Teamrobinson.poffo@einstein.br

CORONARY UNIT(55 11) 2151-5847

Dr. Marcelo FrankenMedical Coordinator marcelo.franken@einstein.br

RN Flavia Fernanda Franco Coordinating Nurse flavia.franco@einstein.br

EMERGENCY DEPARTMENT(55 11) 2151-1464

CARDIOLOGY INPATIENT UNIT(55 11) 2151-1168

RN Claudia Regina Laselva Manager of Clinical Surgical Unit claudia.laselva@einstein.br

RN Wagner Macedo Bezerra Coordinating Nurse wagner.bezerra@einstein.br

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