When the CEO of a global corporation overseeing more than 85,000 employees
in over 160 countries tells you that his job is easier than yours is,
some might rethink their careers. Not Gary Rogal, M.D., Chief of Cardiology
for Barnabas Health, the largest not-for-profit integrated health care
system in New Jersey and one of the largest in the nation. He’s
wanted to practice medicine, particularly cardiology, since he can remember.
Under his leadership, Barnabas Health – comprising seven acute-care
hospitals that serve more than two million patients each year –
has continued to revolutionize cardiac care by offering the latest technologies,
patient-centered services and a dedicated team of specialists committed
to quality and health care excellence.Those two goals – quality
and efficiency – are the key to the system’s success and the
primary focus as it pertains to his responsibility as Cardiology Chief,
according to Dr. Rogal.
“We need to make sure the system’s cardiac services function
the most efficiently with the highest quality possible,” he says,
adding that doing so is complicated as quality is a moving target. “New
quality standards are set all the time, so part of my responsibility as
Chief of Cardiology for the system is to ensure that the Cardiac Program
at each Barnabas Health hospital – plus hundreds of physicians,
nurses and employees – follow the latest practice guidelines down
to their very minute details, all while maintaining the highest level
As a practicing cardiologist himself, Dr. Rogal understands firsthand the
importance of a health system that provides cardiology services as uniformly
and with as little variation as possible – he says it enhances quality
and minimizes the potential for adverse outcomes.
“The evidence-based and uniform approach to care is important in
getting the best results,” agrees Frederic F. Sardari, M.D., Vice
Chairman of the Department of Cardiothoracic Surgery at Saint Barnabas
Medical Center in Livingston.
“Previously, hospitals separated cardiology – or medical treatment
of the heart – and cardiac surgery,” says Dr. Sardari, adding
that today, more and more hospitals are shifting toward providing the
kind of collaborative approach offered by Barnabas Health that’s
being spearheaded by Dr. Rogal. “By integrating the scope of care
we offer under cardiac services, we’re incorporating both medical
and surgical teams to provide a comprehensive approach to patients’
As part of Dr. Rogal’s overall approach to offer integrated cardiac
care system-wide, Saint Barnabas Medical Center recently added a new procedure
– minimally invasive endoscopic atrial fibrillation (AF) ablation
– to its array of treatment options.
The Convergent ablation procedure combines minimally invasive cardiac surgery
and traditional AF Ablation performed in the cath lab to treat patients
with atrial fibrillation, a type of irregular heart rate that is also
known as AF or AFib.
According to Dr. Sardari, the prevalence of AFib and the challenge in treating
it is a vast and expanding problem in this country, as it is costly and
accounts for a major source of morbidity. The traditional procedure uses
ablation techniques to isolate the triggers of AF, either via open surgery
or through cardiac catheterization.
“The new hybrid procedure delivers the best of both worlds,”
says Dr. Sardari, who, along with cardiologist David Dobesh, M.D., performs
the hybrid procedure. “The multidisciplinary technique is about
80 percent effective in treating AFib, far better than the success rate
of traditional surgery or catheterization alone.”
As an attending cardiac surgeon at Barnabas Health’s Newark Beth
Israel Medical Center and Saint Barnabas Medical Center for the past 15
years, Dr. Sardari is an integral member of the hospitals’ Transcatheter
Aortic Valve Replacement (TAVR) teams – with one of the highest
patient volumes. Barnabas Health hospitals have utilized TAVR to successfully
implant aortic valves in more than 400 patients.
“TAVR is a minimally invasive valve replacement that uses a catheter
to replace the valve rather than opening the chest. The minimally invasive
procedure allows for fewer complications, less pain, shorter hospital
stays and a quicker recovery than traditional surgery, and it’s
a particularly good option for older or sicker patients who may not be
good candidates for open surgery,” says Dr. Sardari.
The integration of Barnabas Health’s cardiac services program into
system hospitals has been so successful, Dr. Sardari and his colleagues
at Saint Barnabas Medical Center have taken components of the program
to underserved populations through a partnership with LIG Global Foundation.
In March, Dr. Sardari, accompanied by a multispecialty team comprising
medical specialists and nurses, traveled to Cajamarca, Peru to perform
heart valve surgery alongside Peruvian doctors as part of a training and
educational campaign. Through the partnership, the team will travel back
to Peru later this year to continue helping the medical team there establish
a cardiac surgery program.
While the traveling physicians are focused on educating medical professionals
in Peru about lifesaving cardiac services, education takes a different
form here at home as an important component of Barnabas Health’s
overall approach to cardiac care.
“Barnabas Health is focusing on offering care across the lifespan.
We are taking a more involved role in promoting healthy lifestyles to
prevent various diseases, including heart conditions. We want to promote
prevention, but we’re also available to offer the highest quality
diagnostic and treatment services if people do get sick. Then, once they’ve
been treated, we want to help make sure they don’t have repeat episodes,”
says Dr. Rogal.
Barnabas Health is paving the way for such a comprehensive continuum of
care by offering integrated, coordinated services, including introducing
a program focused on the coordinated care of congestive heart failure
patients in Barnabas Health Medical Group practices and system hospitals’
heart clinics. In this environment, patients receive education from and
care by skilled nurse practitioners who specialize in caring for people
with heart failure. Later, and throughout the course of treatment, these
patients continue to interact with those same specialists to help them
manage their chronic disease.
“We’re not operating in silos – we are offering integrative
programs, fostering coordination throughout those programs, and working
closely together to deliver quality care,” says Dr. Rogal, adding
that patients must take advantage of this integrated system in order for
it to be effective.
“While patient education is very important and something we stress
here at Barnabas Health, it also requires patients to recognize the power
they possess to keep themselves healthy,” he says. “We have
the programs and services people can use to improve their health, but
risk factor management accounts for about 50 percent of the tools in the
box to keep people healthy.”