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The Heart of the Matter

Interventional cardiologists say the human connection is most important

LEXINGTON It’s fair to say that cardiologists understand a thing or two about connections. After all, the human circulatory system is a series of connections facilitating blood flow throughout the body. Heart valves and chambers, arteries and veins are all different components, each integral to the overall goal.

Interventional cardiologists Hussam Hamdalla, MD, and Sharat Koul, DO, both part of the team at CHI Saint Joseph Medical Group – Cardiology in Lexington, excel at diagnosing and repairing faulty cardiac function in their patients. But before all the high-level medical procedures and treatments take place, both say it is a completely different kind of connection that is often the key to achieving positive results for their patients.

“The majority of my time is in the office talking to patients,” says Hamdalla, who, like Koul, previously practiced at Ephraim McDowell Regional Medical Center in Danville, Kentucky. “When I see a patient, I like to understand their background, where they live, what their profession is, what their family is like, because it puts everything into context. It’s hard to simply listen to the complaint without understanding the context of the patient as a human being and what parts of their lifestyle, personal life, or their professional life could be driving some of these symptoms.”

“My philosophy is to function as an advisor to patients,” Koul adds. “My goal is to help them understand all their options and, in the end, work together to come up with a treatment plan that is aligned with their overall healthcare goals. I think the most important thing is to listen to your patients and understand what they really want in life.”

Connecting and Collaborating

You could call it a heart-to-heart talk about the heart. It’s about combining caring, compassion, and understanding with skill and expertise. By joining CHI Saint Joseph Health, both Koul and Hamdalla have had the opportunity to develop their particular skills and refine their specialties.

“We have an excellent team, and the nice thing is we complement each other,” says Hamdalla. “We each have our special kind of niche of things we do, and together between us and our cardiac surgeon, we provide a pretty comprehensive management for cardiac problems.”

“All of the physicians bring a specific expertise in terms of being able to home in on specific parts of cardiovascular treatment,” says Koul, who specializes in limb salvage and cardiovascular disease. “You’re able to hone your skills to specific areas because the field itself is too broad to be an expert at everything,”

Koul sees patients in area clinics in Danville, Lebanon, Lexington, and London three-tofour days a week. Then he spends at least one day in the lab, where he performs multi-hour wound procedures on complex leg patients.

“The care of the wound populations tends to be very much multidisciplinary in terms of care,” says Koul. “I work with one of the best wound specialists in the state on a regular basis and I work with a lot of excellent physicians who do a lot of wound work in general. These patients require a lot of care, and there are a number of different specialties that come together to provide optimized care.”

Koul grew up in the Washington, D.C., metro area, attended the University of Virginia, and then went to medical school at Kirksville College of Osteopathic Medicine in Missouri. He did his residency at Cleveland Clinic and took a cardiology fellowship at Advocate Illinois Masonic Medical Center in Chicago, followed by an interventional fellowship at the University of Kentucky. After working briefly in Atlanta, he moved back to Kentucky in 2011.

Specializing in limb salvage and complex cardiovascular disease means that Koul sees extremely sick patients with a lot of comorbidities.

“They tend to have a lot of multisystem disease processes, which tend to roll into non-healing wounds and ulcers,” says Koul. “I’ve always found that patients’ connections with their hearts were somewhat disconnected. The heart is in your chest, and you don’t really know if your heart function is 50 percent or 30 percent. But I’ve found that patients have a deep attachment to their legs. Patients are very appreciative if you can help them walk and keep their legs because it’s literally part of their everyday life.”

The importance of the patient-physician connection also resonates with Hamdalla, who sees patients in the office at least three days per week.

“My ‘Why’ is to get up in the morning and see those patients that I have been taking care of for 10 years,” says Hamdalla. “I feel like I’m an integral part of their lives. I have patients who come to me to ask my advice for non-cardiac related problems. They will see a different specialist and they come to me and say, ‘This is what they recommended and I refuse to do anything until you tell me what your thoughts are.’ That’s a reflection of the deep trust and bond that I have with the majority of my patients.”

Originally from Jordan, Hamdalla first studied internal medicine at Brown Affiliated Hospital in Rhode Island, and then cardiology and interventional cardiology at the University of Kentucky. Now at CHI Saint Joseph Health, he is the medical director of the cath lab.

“One of the things that brought me to Saint Joseph Hospital is to be able to grow and take the next step in my life,” says Hamdalla. “One“These patients require a lot of care, and there are a number of different specialties that come together to provide optimized care.” — Sharat Koul, DO, CHI Saint Joseph Cardiology Associates

of the things that I have taken on here is tackling complex, chronically occluded lesions that require a special set of skills. Most cardiologists don’t have the experience or the desire to deal with such complex situations. That is one thing that I have taken on to be able to offer patients more options.”

Those options, Hamdalla is quick to point out, include more than just stents.

“Just because we can do it does not necessarily mean we have to do it,” Hamdalla says of stents. “We know that with lifestyle modification, exercise, and appropriate medicines to keep the blood pressure and heart rate well controlled, patients will do as well a majority of the time.”

Patient Population Is Changing

Both Koul and Hamdalla note that their patient populations are becoming increasingly younger, as unhealthy lifestyles become more prominent and troublesome.

“The national health system is going to have to change so that we focus more on prevention,” says Koul. “The cost to our communities is enormous from the standpoint of not only money but also loss of life and functionality of life.”

“The idea that atherosclerotic disease, especially in the heart, is a medical problem rather than a surgical or procedural problem is becoming much more evident,” adds Hamdalla. “Globally, we are going to focus more on prevention, as we should, rather than dealing with things when the milk has already been spilt.”

A positive change in the patient population, according to Hamdalla, is that patients are now more informed about their conditions and options for care.

“I joke with my patients that they have consulted Dr. Google, and I don’t say that in a derogatory way,” says Hamdalla. “It makes it better for the patient if they have done some homework to understand what we are talking about. They come in sometimes with very legitimate questions. The best patients are those who are involved and engaged in their own care.”

Different Presentations in Men and Women

That learning curve extends to physicians as well. Hamdalla points out that there is a better understanding that cardiovascular disorders plague both men and women, contrary to the once-held belief that men were the predominant victims of heart disease. The difference lies not in the frequency of cardiovascular disease, but in how it presents itself in men and women.

“We have learned to appreciate the challenges and the differences in the presentation between men and women in terms of the heart disease symptoms and how to manage them and work them up differently,” Hamdalla says.

While the treatment regimen might differ from patient to patient, Hamdalla stresses that the overall approach remains the same.

“I enjoy building up that long-term relationship with patients, walking through their journey dealing with the disease,” he says. “It is part of my job not to just put that stent in, but also to hold their hand and talk them through it so they can start resuming their lifestyle.”

Connecting information and care to understanding helps build the patient’s confidence, not only in the knowledge and skill of their physicians, but also in their own ability to regain control of their health. Ultimately, that is at the core of what Koul and Hamdalla want for their patients.

“We aspire to be the leaders in cardiac care in the area,” Hamdalla says. “We are working on building and being that place where everybody wants to get their cardiac care at CHI Saint Joseph Health.”