Dr. Kintur Sanghvi: The Virtua Health Leader Transforming How We Treat High Blood Pressure

Anthony Codispoti : Welcome to another edition of the Inspired Stories podcast where leaders share their experiences so we can learn from their successes and be inspired by how they’ve overcome adversity. My name is Anthony Codispoti and today’s guest is Dr. Kintur Sanghvi, Chief of Cardiovascular Intervention at Virtua Health. They are an academic health system in South Jersey that offers a full range of services from heart care and cancer care to urgent care and more. Their mission is to help people be well, get well and stay well.

And they’re known for their innovative outreach programs like a pediatric mobile services unit and the Eat Well initiative. Dr. Sanghvi himself has been recognized as a top doctor by New Jersey Magazine, Philadelphia Magazine and South Jersey Magazine. He has performed over 13,000 cardiovascular procedures, authored multiple research articles, and is a professor of medicine at the Virtua Rowan School of Medicine. He has shared his expertise across five continents and pioneered the use of wrists and foot arteries for catheterizations.

He also serves as director at the Virtua Lourdes Cath Lab where he continues to advance patient focused innovations. Now before we get into all that good stuff, today’s episode is brought to you by my company, AdBacc Benefits Agency, where we offer very specific and unique employee benefits that are both great for your team and fiscally optimized for your bottom line. One recent client was able to add over $900 per employee per year in extra cash flow by implementing one of our innovative programs. Results vary for each company and some organizations may not be eligible.

To find out if your company qualifies, contact us today at adbackbenefits.com. Back to our guest today, the chief of intervention cardiology at Virtua Health, Dr. Kintur Sanghvi. I appreciate you making the time to share your story today.

Dr. Kintur Sanghvi: Anthony, thank you so much for the opportunity to talk to you and your audience and hopefully share our journey of innovation and taking care of patients and being inspirational to each other. This conversation should be.

Anthony Codispoti : Looking forward to it. So, Kintur, you’ve now done over 13,000 cardiovascular procedures. You’ve trained more than 100 cardiologists, launched multiple programs across major hospitals, and you’re helping to shape what the future cardiovascular care looks like.

But I want to go back a little bit to the beginning for a moment. You were 23-ish when this all started, 23 and completely locked in on cardiovascular medicine. What sparked that focus for you? Was there a moment or experience that kind of lit the fire for you?

Dr. Kintur Sanghvi: We started medical school back home in India right after the high school. Having an immediate family member, my mother suffering from heart failure disease, my focus was on cardiovascular physiology and anatomy, more so over the other system. Because your immediate family member has some history of cardiac condition. And as I graduated from medical school around age 22, I would say I had a unique opportunity to work with a cardiologist right out of my graduation as a junior medical registered.

And there it was very obvious that this is what I wanted to do. That spark happened from about 36-year-old guy who had two kids. The president I still remember his face because he was the first patient that really kind of locked me into cardiovascular medicine, particularly interventional cardiology. Who came in in cardiogenic shock, that means the heart rate was low. The blood pressure was in 90s. He had a major heart attack. When he was in the emergency room, he coded. We had to do CPR briefly, came back.

And then the cardiologist who I was working with went in and put a stent in his main artery on the left side called left main artery, also known as Widowmaker. And this is all transpired within time of 25 minutes or less. He fortunately presented in the daytime while we were all in the lab.

And almost somebody would dive in front of my eyes. He’s a very young doctor. Next day, I was holding his hand and have him walk.

And seeing at that time he had like two young kids. This was a very, very rewarding part of practicing medicine. You know, everything we do in medical science does not always yield prompt and solid results. If you look across all the different subspecialty, this one was very appealing because it was, wow, this immediate response. And from that day on, so it was like early on I was locked in because of that particular two reasons that I mentioned.

Anthony Codispoti : I have to imagine that was an emotional experience to be a part of for the first time. Absolutely.

Dr. Kintur Sanghvi: Absolutely. You know, when you are a new medical student and then you graduate from your clinical rotations and now you’re in a real field and everything is very complicated at the time. Everything is very difficult. And in that situation, a quick diagnosis, quick response, quick treatment, all overwhelming, overwhelming. Still remember it. Yeah. As if it was yesterday.

Anthony Codispoti : Does it give you goosebumps still to talk about it?

Dr. Kintur Sanghvi: Yeah, sure. Absolutely. Probably you can sense it.

Anthony Codispoti : Yeah. So then, you know, after your training, you spent over a decade at a major academic hospital in New Jersey. You’re publishing, you’re teaching, performing thousands of procedures. What do you remember about some of those early years?

Dr. Kintur Sanghvi: You know, my journey was definitely not easy. It was difficult. But I would say that after graduating the International Cardiology Fellowship, you know, the first year as you go out in the practice, now you’re on a first call and the patient comes in with, as I say, you know, heart attack, caudigenic shock, somebody who had CPR in the field, things like that. It’s very, very unnerving even though you are trained for it, the day you are taking responsibility of a human life in front of you and also understand it’s not just one person, it’s the whole family and everything that’s connected with that person. It’s definitely unnerving and challenging. But I was very fortunate to have lots of great teachers across my career, great, inspiring human beings around me.

And I felt very comfortable and confident from day one when I went out. But, you know, everything, you know, life takes your places and the journey that you go through, it’s kind of, you know, you don’t know what it’s going to lead to. But international cardiology field, if I think of early days of my after fellowship finishing, being part of a tertiary care academic place, being involved in the cardiology and international cardiology fellowship programs and their training and their upbringing really makes you better at everything you do because you’re now going to think through on every aspect of patient care. And that makes you mature because you’re going to teach somebody, you want to make sure you learn from that process. And when you’re teaching somebody, you want to teach that right. So I think that played a huge role in where I am today is that interaction with the medical students, residents, cardiology fellows and international cardiology fellows and constantly getting involved in teaching and sometimes getting inspired by them, you know, sometimes helping them bring idea to a fruition and getting a research idea executed and get it to a publication. That entire journey kind of makes you get involved 100% on everything you’re doing on every day.

So I would say if I, at a high level, if I think of those early days, I would say that that was like really a fun time. A lot of new learnings. We did a lot of new programs, new procedures. This is also the time when international cardiology field evolved through a lot of new procedures. So we adapted some of those new, some of them we were able to lead the revolution or evolution.

So it was great days. I was really involved in what we call transradial approach. So doing catheterization through the wrist instead of groin. And, you know, again, that’s something I can think of early days that was really…

Anthony Codispoti : Say more about that procedure. What was your level of involvement and how did the idea come about?

Dr. Kintur Sanghvi: So I did my first transradial, the wrist catheterization in 1999 back home in India. The cardiologist with who I was working with in the cath lab those days learned this approach from a Japanese cardiologist named Dr. Saito.

So Dr. Patel, Tejas Patel, my mentor back home in India. And we kind of wanted to bring this approach because it was a safe approach. We did not think that we can easily do this catheterization procedure that we used to do from the groin. And it seemed that would be very safe for patients because it is the anatomy, the groin artery is much more vulnerable for bleeding complication after the procedure. So if you do any catheterization procedure from the groin irrespective of your level of training or experience, it’s just the anatomy, anatomic variation and the location of the artery with the room for bleeding inside the stomach called retropeditonium bleed and inside the thigh can lead to large hematoma. So a lot of patients in those days in 1999 to 2004, I would say if you look back to the history, there was a high mortality associated with this complication.

So you do a very important procedure, you open up somebody’s blocked heart artery, but then the patient ends up suffering from the bleeding or even sometimes you lose the patient from bleeding and semenorrhaging. Versus the wrist artery, which is sitting right in front of the bone, which is having a collateral circulation. That means this is not an end organ artery. If the groin artery gets closed, your leg can get in fact or can get gangrene or you can lose the leg. But here if the wrist artery gets blocked, there is a collateral circulation that continues to perfuse the heart.

So perfuse the hand, I mean to say. And the easy of compressibility against the bone and stopping the bleeding right after the procedure in compared to the groin where it is difficult. So it was coming up from evolving need of patient safety. We got better at balloons, we got better at stance at the heart artery level, but we did not improve anything from where we enter the body and how we reach to the heart.

And that’s how it started. And then I was involved in bringing that procedure to America in a way through my fellowship, through my mentors here in America, Dr. John Kapolas, Dr. Cindy Grimes, the places where I went for fellowship. I had them come with me back home to India and do procedures with my mentor, Dr. Patel in India. So they will do like 200 wrist catheterization in two days and bring that technique over to America.

And that’s how this spread happened, that the radial procedure spread happened through St. Vincent’s Hospital in New York City. And then we continue to experiment and understand as going through what are the difficulties, there is variations in the anatomy, how can we reach to the heart safely, how can this become as good and as safe as the groin procedures? Can we do it just in a regular cases or can we start doing that for heart attack patients? Can we do it for complex coronary blockage and blocking? Should we start doing it for leg artery blockage or kidney artery blockage? Or should we start doing what we call structural heart intervention?

And that’s how things evolve. And that’s where I was kind of very much involved in trans-radial peripheral interventions. My first paper was in 2007 about doing trans-radial iliac artery intervention. That means the arteries in the between the belly button and the hip joint. And then trans-radial structural interventions, trans-radial use for complex coronary interventions. We did research on what happens to the wrist artery after the catheterization. What can we do to preserve the integrity of the wrist artery? We came up with the design of a sheet or the axis that is specific to the wrist artery. We came up with the design of the wire that is specific to the working through the wrist artery.

I had a couple of my own patterns in this area from my research and from my learning on how to improve the axis from the wrist to go to the heart. Something called Railway Sheet Less Access System, which was Cordy Johnson and Johnson worked on that product idea and it’s now available across the world. Then there was a short, tight-tip wire that I was involved in developing. So the things like that played a role in the evolution of the rail approach.

Anthony Codispoti : Let me hop in here because there’s a couple of interesting things that play here. I think one, to sort of zoom out, especially being based in the U.S., I think a lot of times we think, oh, all the world’s innovation comes from here. But this is a great example of, as a Japanese doctor who first came up with this procedure, it was really being advanced in India years before the U.S. had adopted it.

You played a big role in taking doctors to India and say, hey, look, this is better. Look and see how they’re doing it. But then as you’re talking about this, I’m like, oh, so you didn’t come up with the procedure.

What was your involvement? And then you answered that, which was, and there’s a lot of fine-tuning. What’s the correct way to enter the wrist and the different anatomy that we run into in there and the patents that you came up with to kind of improve that process. And as I heard you kind of explaining all of that, you’re also talking about entering through other points of the body. So are there times where the wrist is not the best entry point, even though this has far fewer complications than entering through the groin?

Dr. Kintur Sanghvi: Yeah, absolutely. There are patient situations where wrist is not the best. Sometimes the wrist artery is very small. People who have a dialysis needs, they may be needing fistula for dialysis and you don’t want to enter the wrist artery and disrupt that wrist artery. So there are definitely clinical situations where groin artery access is superior. If we want to use large device, for example, now we do trans-catheter valve replacement, it’s a very large device. You cannot get through the wrist artery to get that kind of device.

So, but let’s say if we dial back in 2008, the first what we call NCDR database paper that talked about radial was published by Guy from Duke University and at that time in America, only 1% of the catheterization procedures were done through the heel approach. Today that number is in upward of 50%, almost 60%.

Anthony Codispoti : And do you think it’s not closer to 100% because still there are some people who don’t know about it or is it because 50% of the time it’s the right choice and 50% of the time there’s a better choice for that particular patient?

Dr. Kintur Sanghvi: I think it’s still not there because of people who have not got themselves into doing it. Some of the older physicians who started it, the groin did not evolve into using radial. There are multiple factors behind it, but if we look at ourself and compare to other part of the world and I want to correct just a little bit, the trans-radial procedure was really not invented by a Japanese cardiologist. Okay, it was first described by Dr. Kampal in Quebec City, Canada and then in 1993 that was for a heart catheterization and for 1993 first angioplasty paper was described by a guy from Netherlands.

But if we look around and if we kind of look back in the history, about six or seven guys or maybe eight guys will play the huge role in spreading this technique across the globe and Dr. Saito and Dr. Patel along with probably Dr. Yiv LaWard and you have the other names that I mentioned are probably part of that.

Anthony Codispoti : And I’m glad that you mentioned that. It just shows the value of this kind of international collaboration and moving new ideas forward. As you were trying to introduce this to more doctors in the US, did you run into resistance from folks that are part of the old school, this has worked forever kind of a thing?

Dr. Kintur Sanghvi: Absolutely, yes. Absolutely, yes. How do you overcome that? So first you need to have a clear understanding why you are doing something is that when you have a right objective, the objective is very clear. It’s a patient safety issue. There is reduced complication, does not matter how good of an operator you are, is about the anatomy, the safety of the anatomy. So when the patient’s safety is your most important priority, people will get you eventually. It’s not about your ability to do something superior to somebody else.

It’s not like that. So first that was one thing that played a huge role. Second thing, the staffing.

When the staffing’s buying came in, the staff really thought, oh my God, why are you doing this? Such a big use. I can tell you some of very well-known physicians in our field, in conferences, when I talk about accessibility, bleeding was said, why would you go to this small wrist artery? There’s a huge pipe here in the groin.

We have closer device. We have a medication called bivaloridine or angiomax that doesn’t allow too much bleeding. Why would you struggle to go through this wrist? So there was resistance all over, but eventually it became a staff involvement that staff said this is much better for patients. They don’t have to hold the groin for hours. They don’t have to worry about bleeding as much. They don’t have to run them or wheel them to cat scan for rolling out bleeding in the groin. It is so simple for patients. They can sit up right away for our catheterization done through the groin. You have to lie flat for four to six hours versus when you are doing it through the wrist, you can sit up right away. You can eat right away.

You can even walk. There are centers in the, many centers of the world, they don’t even have the patient undress below their pants and they just prep the wrist to the catheterization, to the stent and in an outpatient center, they go do this stent procedure, go sit in a chair for six hours, recover and go home. So the staff really started, like a patient started seeing it. Patients say, oh, why do I have to lie flat while the other guy is sitting next to me? It’s sitting up.

So patients drove it. So nothing happens over time. It takes the spread of innovation takes years and it took its own course. There was like a point of chasm from which the spread happened very fast. But in early adopter being in the first 3% of the operator across the globe to start this procedure and to bring it to now where it is, you know, the initial phase took a longer time.

From the point of chasm, it was a faster spread and then people trained each other. And I think it’s a very good thing that happened in our field. We just translated into improving mortality and morbidity for countless lives, I can tell you.

Anthony Codispoti : Do you have any idea what the stats are on that?

Dr. Kintur Sanghvi: I’m difficult to say, but I can tell you from major studies that nearly, let’s say 1% versus 0.1% risk of bleeding. So, you know, if you talk in pure statistical terms, it’s almost nearly 100% or 90% improvement in accessibility complications.

Anthony Codispoti : That’s amazing. And you’ve been involved in a number of other innovations. We’re going to talk about one here in a moment that just received FDA approval. But before we do that, I’m kind of curious to get your perspective on, from having been through this multiple times, is there something that would help speed up the adoption of these new technologies?

I mean, human beings, you know, by our nature, we’re resistant to change, right? Hey, I’m comfortable. This is the way I’ve always done it. This is the way I was trained. But is there something in your experience that’s like, oh, if we could turn this one dial or flip this one switch, or it would help speed up the adoption of these new technologies?

Dr. Kintur Sanghvi: So, it’s a very good question, Anthony. And I think about this a lot, because, you know, everything that we do, every new information has this time to spread. And from, again, a personal experience, you know, somebody very close to me in 1980, died a premature death from cancer, because there was only one cat scanner in the entire state, back home in India, on my state, where I grew up. And the technology was available, let’s say in America at that time, for early diagnosis, it was not there in India, right?

If it was there, it could have been a different thing. So if you look around, and if you look through the stats, the number of people, they lose their lives, or they suffer because of lack of spread of innovation, know how, technique or technology across the globe plays a huge role in mortality and morbidity. For simple example, for anybody to understand, some countries in the world today even don’t have the most life saving vaccines such as polio not given to their kids, right? And so there are multiple factors, and some beyond your capacity, the geopolitical issues and all those things, right? But if you look at the spread of innovation, at every step of the way, whether it is innovator, early adopters, point of chasm, mass adoption, one thing can play a huge role, and that is education.

Education and awareness in each of the states can speed up this whole curve of spread from over 20 years to maybe 15 years or maybe 12 years, if the education is powerful. And I think we are in that space now, we are on a space where there is an over information bombardment, so there’s so much information hitting us from all over the place. But we are also in a situation where the information and knowledge can spread much faster with the global connectivity with, you know, platform like what you are doing, like your podcast, right, is going to connect so many people and bring them to awareness. So I think these right now, we are at also point in the history of human race, where our access to tool to help spread this fast is there, if we use it right.

Anthony Codispoti : I want to talk about another technology that you’ve been involved with, and this is more timely. Reno denervation, I understand recently approved by the FDA. What is this? What’s the problem that it’s helping to address?

Dr. Kintur Sanghvi: So it’s going to be a little bit of a long answer, but let’s define that. First, what is Reno denervation? Reno denervation is a catheter based procedure, a minimally invasive procedure, a same day procedure in which we go to the kidney artery using a catheter and using technologies such as ultrasound or radio frequency energy. We tone down the over active nerves that travels on the outer surface of the kidney artery. So there are nerves that are traveling on the outer surface of the kidney artery, they are called renal nerves. And this renal nerves are what we are denurring. That means we are toning them down, we are reducing their activity by using a catheter from inside the kidney artery and using the energy and the surrounding space around the kidney artery.

Anthony Codispoti : So what is the problem with the nerves being too active? What is that triggering?

Dr. Kintur Sanghvi: So first question was what is renal denervation? So I explained the procedure, what is it trying to address? That’s a longer answer. What it’s trying to address is the high blood pressure. There are many chronic illnesses for us such as, and we’re going to focus on high blood pressure right now, but there’s also diastolic heart failure, sugar control, sugar resistance or type 2 diabetes, obesity, obstructive sleep apnea, heart failure, arrhythmia. There are many other conditions that are associated with this over active nerves. But we’re going to focus on high blood pressure because high blood pressure is the number one cause of death and disability. When we wrote the guidelines in 2017, November on the update of the high blood pressure guideline, the driving principle was that high blood pressure is number one cause of death and disability for human rights.

And imagine that hardly I would say five out of 100 people would think it that way or know it that way. And the reason is, number one, it’s very highly prevalent condition. Every second American adult is suffering from high blood pressure.

Okay. Worldwide about 1.8 billion people suffering from high blood pressure. So that’s number one, the prevalence is high. Number two, high blood pressure over the years affects multiple organ system. It causes effect on the heart artery to increase the risk of having heart artery blockage and its related problems such as heart attack. It can affect the artery to the brain cause blockage and also cause bleeding in the brain and causes different kind of stroke. Hemorrhagic as well as ischemic stroke.

So either bleeding in the brain or lack of blood flow to the brain with that leads to stroke is one of the main causes high blood pressure or uncontrolled blood pressure. It causes thickening and stiffening of the heart muscle and causes what we call diastolic heart failure. Eventually, if continues to heart continues to work against this high blood pressure, this muscle gives up, become dilated and the contraction becomes weak and it’s called systolic heart failure. It also leads to gradual decline of the kidney function. Number one cause for medical dental disease or failure of the kidneys is uncontrolled blood pressure. So people with uncontrolled blood pressure are very much more likely to get dialysis and go on to kidney transplant.

It also affects the memory issue. So there is now clear evidence people with uncontrolled blood pressure are more likely to have dementia in their later age. People with uncontrolled blood pressure are also likely to have arrhythmia such as atrial fibrillation, ventricular arrhythmia. Number one cause for atrial fibrillation across the globe is hypertension and not valueless heart disease.

So high blood pressure affects the multiple organ and a negative remodeling or negative way over the years. The problem is this disease does not cause symptoms. So one in three people who are having high blood pressure don’t even know they have blood pressure. One in three people who know that they have high blood pressure cannot get the blood pressure under control because to date whatever is available all the medications they try medications and despite that they don’t control blood pressure. They try medication they have side effect they cannot tolerate they keep on changing the mats because of side effects and and they cannot control blood pressure. So it does not cause symptoms it’s highly prevalent it affects the body day to day every day when you are talking to me right now and if your blood pressure is 140 versus mine is 120 over next 3.4 years from data if I be extrapolate the data from a trial called sprint trial which was a randomized prospective sham control trial if we look at the trial data and if we apply the index 3.6 years your chances of suffering cardiovascular event is significantly high almost double than mine okay but the lack of awareness of this condition lack of awareness of this implication and as I said you know it’s not going to cause you headache if you got a headache I’m going to take talent right away but

Anthony Codispoti : if you don’t have a headache you don’t even know what what

Dr. Kintur Sanghvi: you’re going to do so that’s the other problem that people are not compliant to their entire pretensive medication so you are a good patient you take care of yourself you go preventive care you go to your primary doctor he says your blood pressure is high I think you need to start taking blood pressure medicine you are 140 I prescribe your medicine I’m your primary physician let’s say for example 50 percent of the people stop their anti-hypertensive medication in the first year of their prescription

Anthony Codispoti : so because of side effects or just

Dr. Kintur Sanghvi: general compliance number one side effects number two the disease doesn’t cause symptoms day to day to the member to take a medicine as your routine and be committed to it if you don’t have enough education and awareness that what it is doing to your body you’re not going to do it

Anthony Codispoti : so what’s sorry sorry doctor what is the root cause of high blood pressure for most folks is it diet too much sodium is it you know carrying too much weight are those risk factors there

Dr. Kintur Sanghvi: so all of them play a role but one of the things that we have known so when I went to medical school in 1990 we were taught it’s something called idiopathic hypertension or essential hypertension it’s something we don’t know what causes high blood pressure but it’s there there has been genetic predisposition there has been a clear establishment of that but one thing that we always thought that oh it’s idiopathic or it’s something called it we don’t know we have clear understanding that sympathetic nerve over activity plays a huge role in calling hyper pressure whether it is associated with genetic predisposition or whether it is part of our current lifestyle our current societal lifestyle but the sympathetic over activity so the body’s fight and flight response comes from a sympathetic nervous system and that sympathetic nervous system over activity plays a huge role and that is why you know the narration so the the root one of the root cause of this is the over activity of sympathetic nerves now does diet play a role absolutely over using of salt processed food junk food that tastes so good does that play a role absolutely yes it does play a role in causing high blood pressure utilization of alcohol frequent use of alcohol tobacco use overweight these are all very well known cause to hypertension but at the root cause is this sympathetic nervous system now there are some other causes something we always learn as we call secondary causes of hypertension or secondary hypertension that means something is causing high blood pressure for example overactive gland that is secreting too much hormones such as epinephrine or epinephrine adenoline or renin or angiotensin those kind of over secreting of hormone can cause high blood pressure but that’s a very small number of patients that suffer from secondary hypertension the less than five percent of the people who have high blood pressure has a known or established cause other than sympathetic nervous system or activity that causes high blood pressure but for everybody else sympathetic over activity is very important when taking a part of the cause of high blood pressure now if I can take two extra minutes or maybe extra minute to explain what is sympathetic nervous system

Anthony Codispoti : yeah just related at all to the vagus nerve I hear a lot of people talking about that are these connected

Dr. Kintur Sanghvi: they are connected everything is connected the whole existence is connected the whole body is connected every organ that are connected with each other and they all work in sync all right

Anthony Codispoti : enlighten us yes please you’re better yeah but the nervous system

Dr. Kintur Sanghvi: the two part of nervous system one is somatic nerve so when you talk fully move your hand or you feel the touch you feel the temperature you feel the pain that’s all come from somatic nervous system that all goes through the spinal cord into the brain to the conscious brain and you perceive and you respond that’s the somatic nervous system and the second is the autonomic nervous system which is lot of things happen in the body while we are talking and the consciously conversing our heart is beating our lung is breathing maybe the food that you consume an hour ago is digesting you know this is so much process the wastage is being discarded through the urine formation the blood is going through a million mile long blood vessel I would say because in the body if you really put them together it’s a very very billions of capillaries or

Anthony Codispoti : microscopy and none of these things we’re actively thinking about or initiating ourselves our body’s just doing it in the background

Dr. Kintur Sanghvi: automatically yes automatically and that automatic regulation of all the organ is conducted by autonomic nervous system which has two components one is the vagus nerve that’s the you know like for every yin there is a yang so vagus nerve and sympathetic nerve sympathetic nerve is a stimulator vagus nerve is a calming down nerve so when you do yoga meditation you know you are activating your vagal tone so you are having a you know calmer response to things your heart rate slows down with that your respiratory goes down with that versus sympathetic nerve you know you say I had adrenergic tribe so I did this and did that and you know I accomplished some most non achievable task because you are on a curve go go your heart rate is working harder your all organs are working at a faster higher basis so that’s the sympathetic nervous system and there is a control that should happen in everybody nature’s design but this control system the negative VCS cycle of overactivity of the sympathetic nerve is what drives the high blood pressure

Anthony Codispoti : and so now the recent FDA approval is is this a device is this a treatment what is this what is it actually look like

Dr. Kintur Sanghvi: there are two devices these are very small about two millimeter or smaller diameter device that goes to the kidney artery and performs the action one is a ultrasound denervation device that is approved which emits ultrasound energy sparing the artery in the artery wall by a balloon that cools the inner surface of the artery and then spreads the ultrasound energy 360 degree in the surrounding of the kidney artery and that’s how it basically disables the nerve by making the outer layer of the nerve dysfunctional and that’s how basically it makes the nerve dysfunctional completely it’s called perineurium and then the second technique is the radio frequency energy which is again a device that is about 1.4 1.6 millimeter in diameter it has a nickel titanium alloy with electrode on it which basically converts electrical energy into video frequency energy and it spreads the radio frequency energy at the point of contact and in the surrounding area through what we call adipose tissue or a fat tissue heating any nerve that is traveling inside that becomes dysfunctional or reduce it so by reducing this sympathetic tone it translates into controlling the blood pressure

Anthony Codispoti : fascinating so with recent FDA approval how long before a patient could actually have access to this

Dr. Kintur Sanghvi: in fact there is the access to the patient now in probably I would say every state in America the approval happened in October November of 2023 right now the you know the last year was the phase of post-approval evaluation and in that there are regulatory agencies that goes through the approval process for reimbursement and stuff so 2020-5 January Medicare approved what we call transition payment or TPT so the current issue is that many insurance companies and but not a reimbursing for the procedure so that was our one of the you know dissipation of innovation limitation as I said geopolitical and a lot of different things as a system-based problems so but that’s the the situation right now January 1st Medicare approved the TPT right now it’s being considered for payment for the procedures and all that by insurance companies so today if somebody suffering from high blood pressure we can still treat them work through the insurance company try to get prior authorization by appeal process and we treat them if they are Medicare patients we can treat them through what we what I just described but that’s that’s you know if we don’t consider as the limitation right now is you know the innovation treatment available across the United States I would say probably almost every state has at least one center which can offer this treatment

Anthony Codispoti : and in what you can use cases is this better than the current treatment is it better for everybody is it better for people who don’t respond or have side effects to the current approaches

Dr. Kintur Sanghvi: Anthony what what and you’re writing you’re really asking very good questions okay so it’s not for everybody this is a new treatment we have time tested treatment as medications medications are being used for over 70 years of course we don’t have a new class of medicine in last 25 years there is no new innovation and hypertension care in last 25 years and this was very much needed you know there was like a definitely a need for new treatment for hyper pressure but there are multiple classes of anti-hypertensive medications that are available for many years so the first line of treatment is your lifestyle modification if you can quit smoking if you can reduce the number of alcohol intake or the drink you have control the salt intake there’s a diet that has been very well studied it’s called death’s diet that is translated into reducing the blood pressure as much as a medication will be a regular aerobic exercise regular aerobic activity yoga meditation all this has been proven in multiple different studies that if you adopt some of this lifestyle it can help improve your blood pressure control significantly so the first line of treatment today is lifestyle modification the second line of treatment is the medication as I said there are multiple classes of medication one might be better than other for you depending on your race depending on your age depending on your coexisting current comorbid conditions like you know if you have diabetes associated with versus if you have heart condition versus your let’s say african-american versus white origin one class of medication may work better than other for you but the medication is the second line of treatment people who cannot tolerate medicine who have tried medications but cannot control the blood pressure so something called failure of treatment then there is something called resistant hypertension where people are taking three classes of medication they’re taking three different medication they are regularly taking their meds they’re very compliant to their medications they have tried their diet exercise etc whatever the best they can do because you know idealistically for a physician it’s very easy to say do exercise do this do that by thinking also one can say yeah yeah I will do that but executing that on a every day in a current societal lifestyle that we live in may not be for everybody so you have tried your best that you have tried medication so you’re taking three classes of medicine but your blood pressure still remains uncontrolled it’s called resistant hypertension that means the blood pressure is resistant to the current form of treatment so those are very good patients to consider this treatment so this is a hypertension people who have tried and fail the treatment or they cannot tolerate the medication can a young person think of this as a alternate to blood pressure medication can I like let’s say I’m now 40 and I need blood pressure medication I’m concerned about side effect and taking it every day can I try this for sure the clinical trials supports that clinical trials is yes these patients are more likely to respond to renal denervation in compared to people who are in their 60s with multiple medications okay but currently do we recommend that to young people now we still say that go for lifestyle and medication is your first line of treatment it changes in case if you suffered an event so let’s say if you had a heart attack you had a stroke you had a heart failure you had arrhythmia you had a kidney failure or kidney function going down not necessarily completely faint kidney but your kidney function is declining because of uncontrolled blood pressure in those patients we recommend they should go for renal denervation

Anthony Codispoti : because they need a quicker fix

Dr. Kintur Sanghvi: they’re more at risk they’ve already showed us they already showed us that look I’m suffering you’ve got to do something whatever you have done so far has not worked so those are the third class or third group of patients that I would say we want to offer them treatment right are

Anthony Codispoti : there any known side effects to the renal denervation

Dr. Kintur Sanghvi: once again very good question you’re talking like you’re a patient so the procedure was deemed very safe when FDA panel I was fortunate to be part of the panel presenting to the FDA panel about our findings from research trials on renal denervation and I can tell you this panel is solid this panel that FDA convene for both the both the devices presentation they’re like some geniuses who have done 600 800 publication from across the globe FDA put this panel together who are really objectively examining every point of data that is presented to them whether they should approve this device for treatment of high pressure or not and one thing that was unanimous all these people were there that this procedure is safe based on the clinical trial data the risk of any major side effect or complication was less than 1% the main complication was the accessibility bleeding for the groin so right now this procedure you can only do through the groin approach but as you can imagine evolution continues very soon we’ll be doing this through the radial approach there are device iterations and all that being considered delivery systems are being considered and all that well I’m sure will happen in one day but right now we do it through the groin and the common most side effect was associated with the groin accessibility bleeding which is about 1% the risk of any effect to the kidney we were concerned that would this require multiple procedure would this because nerves do regenerate would the nerves recrow again and they will require the procedure so far we don’t see that on the contrary we see that that there is an incremental effect if you look at the three years graphs so we have 36 months data from multiple trials that shows that persistently there is a reduction or maintenance reduction of the blood pressure at three years the third concern was that what if we change this nerve physiology for the kidney with the kidney function decline and we have data that at three years the kidney function remains same so we look at the what we call glomerular filtration rate or creatinine level so there are parameters that we value the kidney function with and the kidney function is not changing over three years so there was a rare side effect of the artery where we are putting the catheter and this device through can we traumatize that artery and there was about one in 900 to 1000 reporting of requiring additional procedures such as a stent placement if there was a disruption of the kidney artery so those are the potential side effects

Anthony Codispoti : this is a crazy idea and a very selfish one but as somebody who suffered from kidney stones before I wonder could this device in a different frequency be used to help prevent the the accumulation of the calcium oxalates in the kidney there and I know that’s outside sort of your area study your expertise but something it occurred to me so I have to throw it out there

Dr. Kintur Sanghvi: yeah no I don’t think so this energy is not at a level where it can break the calcium oxalates stain if you use that you know you’re asked to use directly next to it and you have to always think that everything that we do comes with so as a physician I always say to my patient always say to my fellows that everything that we do comes with a price these are good and the bad and that’s why the hypocritical oath of do no harm because everything that we do can come with a harm so if you think about this ultrasound energy or radio frequency energy if we use it too much high frequency it can start affecting the surrounding organ it can cause strictures it can cause the effect on the intestine it can cause the effect on the kidney medulla or the functional unit of the kidney so no it’s not okay

Anthony Codispoti : fair enough I had to plant the seed just in case

Dr. Kintur Sanghvi: that’s just how the innovation starts

Anthony Codispoti : yeah crazy ideas that will have field and we’ve got a few minutes left together and I want to make sure we talk about you know with your experience Dr. Sangvi probably work in all kinds of places you know lots of places would be lucky to have you and your skill set how did the opportunity to join the virtual health system come about and why did you choose to plant your flag there

Dr. Kintur Sanghvi: I think more than important question of how did the opportunity came about I think why I decided to join as a more more pertinent question and I think virtual as going through transformation being in New Jersey for since 2009 knowing a little bit about virtual health because you know virtual health was a small community-based organization but they had a solid connection with their patients they’re solid good quality clinical programs and solid financial practices so the organization grew organically very fast so in 2017 or so I believe they built a new hospital in Voorhees now at this point they are still a community organization in 2019 they buy virtual our Lady of Lords it’s a tertiary care hospital with open heart surgery license in New Jersey there’s a certificate of need to have an open heart surgery program and you cannot open new program because you want to you can only get if the state approves that so they acquire this hospital as a tertiary care in 2023 January they you know took over the virtual one medical college so if we look back what they came in with is they had a solid you know foot on the ground connection with the community well recognized in the community sound financial practices from there they grew and they’re going through this what what what from top down the system says is the academic transformation so and if you can see that journey back so I was entering at a point where you know it’s you know the early adoption is done and now I’m almost at the point of Chasm where I can now you know grow multiple program multiple research programs initiatives and there’s a perfect ecosystem and there’s a perfect opportunity so it was for me in my career was perfect opportunity because what virtue has doing as an institution what I was seeing on a sideline on how they grew from 2010 to now and it made perfect sense for me to be part of this organization

Anthony Codispoti : what is it that you’re most excited about at Virtua being a part of going forward with them I think the

Dr. Kintur Sanghvi: solid presence across three county large volume of patient a very organized systemic leadership where there is a proper chain of command with the proper direct directions and a unified approach to clear objectives and clear goals I think those are all very solid positive things for for organization to have and I’m very fortunate to be part of it

Anthony Codispoti : do you attribute all of that recent growth in the last 10 or 15 years to the leadership that’s there are there other factors that are kind of at play that has allowed for this accelerated growth

Dr. Kintur Sanghvi: honestly I am not sure if I do have a complete vision to kind of really answer that question because I don’t like to answer the question if I don’t have clarity

Anthony Codispoti : I appreciate that that’s rare in today so tip of my hat to you for that one let’s see we’ve just got about five or ten minutes left I I guess we’ll kind of wrap up with this question but before I ask my last question I I like to do two things that first of all I like to invite everybody to hit the follow button on their favorite podcast app so they can continue to get more great interviews like we’ve had today with dr kinter sanghvi from virtual health and I also want to let people know either the best way to get in touch with you or to follow your story doctor what would that

Dr. Kintur Sanghvi: be to for for patient encounters or for somebody who wants to you know get an opinion for their healthcare from virtual dot org or virtual health website you’ll be able to easily find the lead to get an appointment

Anthony Codispoti : is there somewhere like if people are interested in kind of the innovations that you’re a part of and you know kind of following more of that story that they can look for that info

Dr. Kintur Sanghvi: yeah so we do have our organizational website which talks about the research that we are doing but I’m also kind of active a little bit on the social media for any important innovation that’s happening in our field with the twitter and linkedin

Anthony Codispoti : okay great we’ll look for your profiles and include those links in the show notes so I think maybe where I want to kind of wrap up today doctor you know we’ve got to touch on just a couple of the innovations that you have been a part of is there’s something else that’s brewing that’s in the works that maybe you’re particularly excited about or that’s coming that you want to give voice to um

Dr. Kintur Sanghvi: I think the right now you know the use of the technology in improving the procedures improving the access to the patient early diagnosis of under diagnosed undertreated problems is something that right now I’m really kind of focused on and excited about because the goal is health and people who are not diagnosed are not aware of their problem and their consequences if we can when there is a evidence-based support to that identify and treat them and prevent the consequences so just for an example I want your help people would not have colonoscopy as a preventive care X number of people were given a ladder because based on the AI search that they did not have that they were sent out information some of them chose to do it from let’s say about thousand patients chose to do the colonoscopy 250 of them were identified to have a polyp that could have grown into cancer and was removed and neutralized right so that’s just the most simple example that I’m giving that can be understood by anybody but in our field in cardiovascular medicine and international cardiology and many other things I’m working on that so I think that’s very exciting

Anthony Codispoti : what do you think are the biggest levers to pull to get sort of increased improved diagnosis levels because I mean every time I go to my doctor heck even my dentist you know they take my blood pressure and so like that’s a point of reference for me oh still good still good still good but clearly there are people who are not even taking those steps and so how do you reach those folks do you have any thoughts on

Dr. Kintur Sanghvi: that difficult but it has just started early age in my my and I think it is being done in overall US education system I hope we bring back the focus again a little bit more because you know like everything else on depending on the need of the time you know for last few years our focus in the education system was on different things but I think the chronic illnesses the cancer the heart attack the stroke the hyper pressure the diabetes and early on education of good lifestyle good diet activity that is good for physical and mental health and awareness starting at early age would be the best way to do that’s the only thought I have again beyond that I don’t have much clarity to kind of see how we can bring population on board

Anthony Codispoti : yeah it’s it’s a tough question to answer and just kind of a follow-on because you know you made the reference to colonoscopies and sort of using AI to identify folks that you know might be at risk and we benefit from a colonoscopy and as somebody who’s you know heavily involved being at the forefront of different cardiovascular tech are you seeing ways that AI is being used in your field currently that you’re excited about or something that’s kind of coming it’s it’s coming soon

Dr. Kintur Sanghvi: um yes it is happening it is here it’s already happening it’s exciting whether it is characterizing the significance of stenosis of a blockage in terms of anatomically that means how much percentage stenosis is there and in terms of physiologically evaluating the blood flow beyond the just based on the angiography just based on the one angiography film it’s here there are other tools under development that will play a role we have AI used in implanting valves so we can we can create three recreate a three-dimensional model for an individual patient’s anatomy if I’m changing their valve today and if that valve fails 10 years from now you have to change that valve again I can implant those valves virtually in a three-dimensional model and see what it would look like and would it work and there are a lot of nuances that’s a big complex question but the technology is here it’s here it’s a starting point

Anthony Codispoti : yeah this is great stuff and I know that we just kind of scratch the surface in terms of the different innovations you’ve been a part of it’d be fun to have you back on in a year or two and see kind of what new things you’ve gotten your fingers into but Dr. Kintur Sangb from Virtua Health I want to be the first one to thank you for sharing both your time and your story with us today I really appreciate it

Dr. Kintur Sanghvi: I would like to be the second one to say thank you for the opportunity to talk to you and your audience and hope our conversation can inspire some people to live healthy some people to change their lifestyle some people to seek help for their medical condition to their doctor and hopefully if we can even prevent one stroke or one heart attack it’s a big win

Anthony Codispoti : love it folks that’s a wrap on another episode of the inspired stories podcast thanks for learning with us today thank you you