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eRounds - Summer 2012

The Power of Today:

Referring Your Patient to Cleveland Clinic

Cleveland Clinic’s Referring Physician Center has established a 24/7 hotline for referring physicians and their office staff to streamline access to our array of medical services. Our goal is to make it as easy as possible for you and your patients when you entrust us with their care.

You can contact the Referring Physician Hotline to obtain information on our clinical specialists and services; schedule and confirm patient appointments; receive assistance in the resolution of any service-related issues; and connect with Cleveland Clinic specialists.

“We made physician referrals a priority,” says James Merlino, MD, Chair of the Office of Patient Experience. “We looked at what worked and what didn’t work. We collaborated with referring physicians to develop a one-stop shop for all their needs. The result of this teamwork is the Referring Physician Center and its hotline.

Today, we’re here 24/7 to give quick service and rapid resolution of any issues.” Cleveland Clinic will work with your patient to complete the registration process and to schedule an appointment at the patient’s convenience. You will be notified once the appointment is scheduled.

“Patients honor and respect their personal physician,” says Dr. Merlino. “We realized that if our referring physicians are not happy, their patients won’t be happy. The Cleveland Clinic Physician Referral Center will do whatever it takes to give all referring physicians and their patients the best outcome and experience.”

The Referring Physician Hotline can be reached 24 hours a day, 7 days a week, by calling 855.REFER.123 (855.733.3712).

Resistant Hypertension

Do you have patients with resistant hypertension? You might want to recommend that they enroll in a clinical trial of a treatment that attacks high blood pressure at the source: the renal system.

Radiofrequency ablation (RA) is a method for neutralizing specific nerve function. A transponder-tipped catheter is threaded to the site of the targeted nerve, where it delivers a mild energy pulse that puts the nerve permanently out of commission. RA is being successfully used to treat back pain, heart rhythm disorders like atrial fibrillation and other disorders. Now it’s being applied to the nerves that line the renal arteries as a treatment for resistant hypertension.

Renal nerve RA is applied using a device called the Symplicity® Catheter System™. Medtronic, the manufacturer of the device, is sponsoring a multicenter clinical trial under the leadership of Cleveland Clinic. The procedure takes 40 minutes and is performed via catheter through femoral access. The tip of the catheter delivers multiple two-minute pulses of radiofrequency energy to nerves in the renal sympathetic system.

Early indications suggest that the treatment has the potential to lower resistant high blood pressure permanently. “Unless we’re missing something, this is a technology that’s transformative … It’s a really big deal,” says Steven Nissen, MD, Chair of Cardiovascular Medicine at Cleveland Clinic.

The device is currently approved and available in the European Union and Australia. Renal denervation for uncontrolled hypertension was named the top Medical Innovation of the Year at Cleveland Clinic’s 2011 Medical Innovation Summit.

Cleveland Clinic is helping to enroll 530 patients with uncontrolled hypertension in a study that will help obtain FDA clearance for the system. The Symplicity HTN-3 study is a multicenter, prospective, single-blind, randomized, controlled study of the safety and effectiveness of renal denervation in subjects with uncontrolled hypertension. Bilateral renal denervation will be performed using the Symplicity Catheter — a percutaneous system that delivers radiofrequency energy through the luminal surface of the renal artery.

If you have patients with uncontrolled hypertension who would like to enroll in this trial, please contact Mehdi Shishehbor, DO, at 216.445.6397 or 800.223.2273 ext 56397.

Alzheimer’s Disease Redefined

Your older patients have many questions related to the aging brain. These can be hard to answer. Conditions like Alzheimer’s disease are an ongoing challenge to physicians and researchers. Recent breakthroughs at Cleveland Clinic, however, are expanding knowledge of the disease and taking the challenge to a new level.

The way that geriatricians are defining and diagnosing Alzheimer’s disease (AD) is in the process of profound change. Until recently, the criteria for a diagnosis of AD focused mainly on dementia. But this is changing. It is now known that AD begins developing long before the onset of its best-known symptom. Jeffrey L. Cummings, MD, Director of the Cleveland Clinic Lou Ruvo Center for Brain Health, says, “AD could be present for about 10 years before the patient begins to manifest the symptoms that meet our criteria for Alzheimer’s dementia.”

According to the new definition, AD is subclassified into three phases: the clinically asymptomatic phase, the prodromal phase (also known as “mild cognitive impairment”) and the dementia phase.

“During the clinically asymptomatic phase, patients are completely normal, but we can determine by the presence of various biomarkers that AD is present,” Dr. Cummings explains. “After approximately 10 years, patients enter the prodromal or predementia phase. This is the period when patients begin to notice signs of memory impairment. Finally, as the disease progresses, patients enter the dementia phase that we are all so familiar with.”

The expansion of the definition of AD comes at a time when Cleveland Clinic is expanding its own role in geriatric care. “We have begun to develop an integrated network of clinical services and research activities throughout Cleveland Clinic,” Dr. Cummings explains. “Among these programs are the Brain Health Initiative and the Center for Brain Health Knowledge Program.”

The Brain Health Initiative is a coordinated, multidisciplinary plan that combines elements of diet, physical exercise, mental exercise and lifestyle counseling to optimize brain health for older patients. “For example, one of its components is a memory-testing exercise that can identify people who are beginning to undergo brain changes so that they can be referred for a more targeted clinical evaluation.”

The Knowledge Program is a software-based electronic medical record that is customized for dementia patients. It helps clinicians conduct patient interviews by prompting them with a standardized set of questions and suggesting avenues of inquiry. “The goal here is to make sure that every patient who is being evaluated receives the same high-quality assessment. It’s a way of ensuring that nothing is overlooked. Once we perfect it internally, we plan to make it available to institutions and community practitioners throughout the world. We hope to take the next step by the end of the year.”

Dr. Cummings and other neuroscientists are in the midst researching of tests to inexpensively detect AD in its earliest stages. Studies are under way on a neuroprotective compound that may actually prevent Alzheimer’s rather than just slow it.

Unfortunately, research in AD has been slowed by the lack of an adequate number of patients to populate clinical trials — a fact that Dr. Cummings hopes he and his staff can change. “I would ask all primary care physicians to consider referring their AD patients for clinical trials. In most cases, the drugs and the imaging are free of charge.”

For an appointment or to arrange for a brain health consultation, please call 866.588.2264.