The research program is one of only a few such programs in Arizona selected by national cardiac drug and device companies to conduct research trials on their products. The ACS research program also is a center of the Duke University Clinical Cardiology Studies Consortium. The research is overseen by Robert M. Siegel, M.D., primary investigator and medical director at Advanced Cardiac Specialists. The research program is directed specifically toward clinically relevant problems. "We believe this will help us provide the best possible diagnostic and therapeutic options to our large and ever-increasing patient population."

"When we talk to patients about participating in research trials," Bhaskaran said, "sometimes they, or their relatives, feel apprehensive. They think such trials are experimental and risky, when, in fact, their purpose is to improve the patient’s quality of life."

Heart Drug Research

Most cardiac drug trials last 12 - 16 weeks, during which patients are closely monitored according to strict protocols set by clinical scientists/physicians and approved by the Food & Drug Administration (FDA). "The patients receive the very best personal care that modern medicine has to offer, and it’s free," she said. "They develop a great rapport with the research staff and are encouraged to call with any questions or problems, at any time of the day or night." Currently there are 28 ongoing trials, including heart failure, myocardial infarction (heart attack), arrhythmias, pacemakers and newer angioplasty and interventional devices.

Dr. Bhaskaran related the story of a 53-year-old patient who was taking a trial drug for heart failure as the result of a heart attack years earlier.

"The only reason she entered the trial was because nothing else was helping. She was very negative, especially as she didn’t notice any improvement until after she had been on the drug for four weeks. However, now, she is doing so well; there has been such an improvement in her quality of life, that it has changed her whole outlook. Now, she is so receptive, like a good friend. She has become our spokesperson encouraging prospective and current research patients, now that she’s experienced the difference first hand. There was a period when she had a hard time breathing. Now she is free of symptoms, exercises daily and has returned to full-time work, " Bhaskaran said.

She said drugs used currently in clinical research trials are not mystery potions. "We know what the drugs are about, and they usually are an improvement when compared to current medications. We’re starting with a knowledge base and therefore an advantage."

After drug trials are completed, patients may decide, with their physicians, whether to continue the trial medication in what is called an "open phase," or return to using regular prescription medications. Physicians continue to monitor patients in the open phase until the medication is available on the market.

Cardiovascular research at Advanced Cardiac Specialists also involves studies of various newer devices and procedures to treat coronary artery disease. These include: laser angioplasty to remove plaque from artery walls; stent implantation to keep coronary arteries open after angioplasty; rotablator procedures to drill through plaque in small vessels; atherectomy to cut through and remove plaque from larger vessels; and TEC device to treat degenerated vein graft disease.

Dr. Bhaskaran has numerous publications to her credit in international medical journals and was recognized as an "Outstanding Researcher" by the U.S. federal government. Her research work involves both non-invasive and invasive cardiology studies. "ACS is able to conduct research under the best possible circumstances by combining the academic advantage of a university medical center with a large and diverse clinical population. This research environment is further enhanced through state-of-the-art technological support, conducted and interpreted by a team of experienced physicians."

The research program, Dr. Bhaskaran said, has been prestigious and successful "because of our record of being meticulous and the maintenance of a high standard of patient care while putting newer drugs and devices through these stringent trials. The doctors are very supportive and the research staff so committed. Our success is in large part due to Dr. Siegel’s stress on research and advancement, as a means of keeping the practice on the cutting edge, and as a commitment to continued quality improvement."

In addition to Dr. Siegel, Dr. Bhaskaran, and the other physicians at ACS, other members of the research department include: Jennifer Vermillion, director.

Prague, Czech Republic, September 21-24, 1997
Advanced Cardiac Specialists (ACS), a leading cardiovascular and internal medicine -based practice with multiple city and statewide offices,  received worldwide recognition in its efforts to provide state-of-the-art management of cardiovascular disease to patients from across the United States, Canada, Mexico, and Europe. This is reflected in the benchmark number of original scientific research papers (fourteen in 1997 alone) that ACS cardiologists have presented and published at international cardiology conventions throughout the United States and Europe.

This was acknowledged by the international scientific fraternity, when ACS received the unique honor of an invitation to participate in the "First International Congress on Coronary Artery Disease - From Prevention to Intervention", held in Prague, Czech Republic, September 21-24, 1997.

The ACS team was represented by: Dr. Robert Siegel, Medical Director of ACS; Dr. Ambika Bhaskaran, Medical Director of Cardiovascular Research at ACS; and Dr. Barbara Barker, Senior Consultant in Internal Medicine at ACS. In the presence of eminent leaders of the international medical fraternity, we presented three papers of original research, related to evolving techniques in the treatment of complex cardiac problems. The papers discussed various aspects of management of coronary artery disease, including optimal treatment options, long-term clinical outcomes and rehabilitation of patients after an acute myocardial infarction. This research was based on ACS’ computerized Interventional Patient Registry experience, of almost 2,000 patients.

Other important contributors in this effort included: Dr. Alvin Nuttall, Senior Consultant in Internal Medicine and the Research Coordinators at the ACS Division of Cardiovascular Research.

On October 24, 1997 a 16 member multidisciplinary medical team embarked from New York to Dakar, Senegal. Their mission: to establish much needed cardiovascular health care in this West African nation, where the average adult life-expectancy is only 56 years. The team was led by Dr. Albert F. Olivier, a cardiovascular surgeon practicing in the Phoenix area, and consisted of cardiothoracic and general surgeons, anesthesiologists, cardiologists, internists, public health experts, dermatologists and gynecologists. Ancillary services were provided by operating room/intensive care nurses and a biomedical technician. Advanced Cardiac Specialists was represented by Paul L. Underwood, M.D., F.A.C.C.

The concept of Project MEDHELP evolved during the Third African-African American Summit held in Dakar, May 1995. The result was this two week educational mission sponsored by the Phoenix-based International Foundation for Education and Self-Help (IFESH), a 15 year old nonprofit organization involved with national and global community initiatives, promoting development in the areas of health, education, agriculture and economy in underdeveloped countries.

With only 432 physicians in the country, the doctor-to-patient ratio is 1:18,410. Rheumatic heart disease is by far the most frequent condition encountered in the Cardiology Department at Hospital Dantec, the teaching hospital for the University Cheikh Anta Diop de Dakar (formerly University of West Africa). Heart failure is the most frequent rheumatic complication (38%). This is followed by atrial rhythm disturbances and endocarditis. The death rate for rheumatic heart disease in Senegal is 13%. There was no balloon valvuloplasty or heart surgery available there, until these missions began.

Hypertension is another leading cause of heart disease in the general population of Senegal. It is the second leading admitting diagnosis to the Cardiology Department. The mortality rate for hypertension related admissions are 7%.

Senegal has yet to develop a dedicated Pediatric Cardiology Unit making the detection and treatment of congenital heart diseases especially challenging.

Lack of complete equipment and limited surgical possibilities make aggressive management of coronary artery disease virtually impossible in Senegal. The average length of stay for those admitted to the Cardiology Department is three months; primarily due to very limited medical resources for the patients once they are discharged home, but also partly because there are no surgical options to effectively treat valvular heart disease.

Only one cardiac catheterization had been performed in Senegal prior to the medical team’s initial visit. During their stay in May,1996, they completed seven cases: four for coronary disease and three for congenital heart disease.

Two heart-lung machines as well as replacement parts to repair damaged equipment accompanied the physicians on their second trip in October, 1996. Fifteen cases were performed then. The developing self-sufficiency of the mission was evidenced by the 30 cases that were performed prior to the next visit in May, 1997 when an additional 15 cases were performed. These included two cath lab interventions performed to save "blue babies" suffering from severe congenital heart disease. This mission also realized successful heart valve replacement surgery in eight patients and the establishment of an ongoing nationwide, multidisciplinary committee for the prevention of rheumatic heart disease.

Venues on the horizon for project MEDHELP include Haiti, Zimbabwe and Nigeria. As global communication and global interdependency continue to grow, projects such as MEDHELP become vitally important in linking the rapidly expanding world of medical technology to include those who have previously had limited access. Empowerment -based missions are more culturally adaptable than the colonial methods used during the Industrial Revolution and will likely be a more effective way of using the world’s cumulative knowledge to reach out and help less fortunate patients all across the globe.