Cardiologist Specially Trained to Treat Those With Great Need, and High Risk
One in an ongoing series.
There is a risk-treatment paradox in interventional cardiology: the sickest patients, who are most likely to benefit from treatment, may also be the least likely to get the treatment they need.
That’s the reality that motivated Sanjog Kalra, MD, to complete a fellowship in the emerging specialty of treating high-risk heart disease patients who are often denied necessary medical procedures for fear of complications or because of the complexity of their disease.
Dr. Kalra, Director of Complex Coronary Intervention at Einstein Healthcare Network, is one of only a handful of interventional cardiologists in the United States to be formally trained in the management of “CHIP” or Complex Higher-risk (and Indicated) Patients who suffer from extensive heart artery disease. Interventional cardiologists treat heart and vascular problems with nonsurgical, catheter-based treatments to restore blood flow through the heart’s own circulatory system.
“Every doc who sees a CHIP patient gets a feeling like there’s a baseball being thrown at their head,” Dr. Kalra says. He sought CHIP training so he could learn to “catch the baseball instead of trying to duck.”
High-risk patients are especially prevalent in poorer communities, Dr. Kalra says, because patients often delay seeking medical care until their conditions become dire. More and more people will fall into the “high-risk” category as the population continues to age, he says, requiring more expertise to address their complicated medical needs.
These patients need blood vessels reopened to restore blood flow to their heart, but the challenges are daunting. Their arteries have extensive calcification because they’ve been obstructed for so long or grafts from a previous bypass have closed; or their hearts are so weak they can’t absorb the 30 to 60 seconds it takes to block a blood vessel to repair it; or they have chronic kidney disease, so they can’t endure the use of dye contrast to see inside their arteries and heart; or they have other diseases that put them at risk of serious complications from the procedure.
They’re more likely to have poor outcomes, so some doctors are reluctant to intervene. “As docs, we don’t want to hurt anyone,” Dr. Kalra says.
“These patients come into the hospital and they’re unable to breathe, they’re unable to exercise,” he says. “I had one patient say, ‘I feel like I live in a box and the box keeps getting smaller and smaller.’” Dr. Kalra is gratified when he can get them out of the box.
“I always wanted to have a big impact,” he says. “I always wanted to take care of people who needed me the most. My belief is when you’re really sick and someone helps you, that individual has an impact.”
Dr. Kalra was in subspecialty training in Canada, where he was born, when he attended a medical meeting in New York and met leading practitioners in the field of interventional cardiology, including Drs. Jeffrey Moses, Ajay Kirtane and Dimitri Karmapliotis – all pioneers in the subspecialty. He sought and was offered Columbia University’s first fellowship in CHIP training. Dr. Kalra moved to the United States to take it, and then came to Einstein.
Dr. Kalra is invited to speak all over the world about his CHIP training and the management of these complex patients. Nowadays his phone often rings in the middle of the night with a call from a doctor treating a patient in another country, asking for advice.
“The strength of the program we have here is because of the relationship we have amongst one another,” he says, citing his close alliances with his interventional cardiologist partners here at Einstein.
“As a team, we work very hard never to say ‘No,’” he says. “Just because the patient is harder to treat, it doesn’t mean the obligation to treat them has changed. You do whatever you have to do to provide patients the care they need. That is, after all, the real reason we’re here.”