Rosy Thachil, MD, MBA, FACC, FAMWA, FACVC, Cardiologist at NYC Health + Hospitals/Elmhurst

Welcome to the Becker's health care podcast. I'm Mariah Taylor, assistant editor and I'm thrilled to be interviewing Rosie Thatjil, director of the cardiac intensive care unit and co-founder of the Women's Cardiovascular Institute at NYC Health and Hospitals Elmhurst. Dr. Thatjil, thank you so much for joining me today. I'm really excited to learn more about what you're doing at the Women's Institute. But before we dive into that, I'd love to hear a little bit more about you and your background. Yeah, thank you for having me. So as you mentioned, I run the cardiac intensive care unit here But we also recently co-founded last year the Women's Cardiovascular Institute and I think this topic is very timely I know we just came off with a heart month, but really cardiovascular health is a year-round issue So we love to talk about it, you know, every month and this is an institute we co-founded between myself Dr. Dieth 3Sedia and Dr. Deborah Reynolds. So excited to be here and to share information about it Absolutely, and as I'm sure you're aware and all of our listeners There's a lot of systems right now that are opening either service lines or institutes or even clinics Specifically for a different population group. So I'd love to just hear your opinion and understanding of what's behind all of this movement towards specialized care by population Yeah, a great question. So at its core It's about recognizing that health care has historically been built around a one-size-fits-all model But patients are not one-size-fits-all and different populations experience disease differently They face different barriers to care and often they arrive in the health system through different pathways also So if you want to truly deliver effective care We have to design programs that acknowledge those realities and cardiovascular disease is a perfect example It's the number one killer of men and women yet women have historically been under recognized under diagnosed Misdiagnosed and underrepresented in research as well and so that realization it is one of the driving forces Behind launching the Women's Cardiovascular Institute at almerced. We wanted to create a program where women symptoms risk factors and life Experiences also things like pregnancy, menopause, or fully integrated into cardiovascular care So in many ways, especially as care by population group is simply just good medicine It's about meeting patients where they are and then designing care around the realities of their lives Absolutely, and what are some of those changes that you're making to your services to meet the needs of women? Yes, almerced series of one of the most diverse communities in the world our patients actually represent a myriad of cultures, languages, backgrounds, life experiences I actually there are about 250 languages spoken within just a small radius of the hospitals incredibly diverse and This diversity fundamentally shapes how we think about delivering care and because of that We've recognized that there was a real unmet need for dedicated women's cardiovascular care in this community Many women we see are not always aware that cardiovascular disease is their leading health risk and What makes our program particularly unique is that it sits within a community and public hospital system So as you alluded to earlier many women's heart centers are popping up around the country Many women's cardiovascular programs sit within large academic medical centers in the country But access to specialized cardiovascular care shouldn't really depend on where you live or your insurance status or the center that you have access to It's really an equity issue, and so that's why we felt strongly about building this particular program We also built this program to be comprehensive across the entire cardiovascular spectrum from prevention to critical care So we have a few initiatives that are embedded in our in our women's heart program So for example a postpartum hypertension program and this program recognizes that pregnancy is often an early cardiovascular stress test We also have a post-CSU clinic, which actually helps our women patients recover after Critical illness and transitioning back to normal life We also have a breast cancer or cardiotexicity program where we work closely with our oncology colleagues to protect the long-term Health of the heart so at the end of the day the goal is not just to treat disease when it appears But also to identify risk earlier and close gaps and care that disproportionately affect women And you know, perhaps the most meaningful feedback we hear from our women patients is simply, you know This is the first time I felt somebody really listened to my symptoms And I think that's when you know that the model is working Absolutely. That's got to be lovely to hear and I'd love to dive into that even just a little bit more Because every system's doing these women's services a little bit differently So for your service area, what are some of the services that are in the highest demand? Yeah, so I think women's heart in general is in high demand, right? We know that women's heart women's cardiovascular disease. It's the number one killer So it's it was a need that was unmet for years and now we're able to bring that specialized care to this community And like I mentioned before we have other specific programs within the umbrella of the women's cardiovascular Institutes for the postpartum hypertension program the post-CICO clinic the breast cancer cardio toxicity program the cardio obstetrics program So really we're we're really just in the infancy this program is only one year old But we're really really excited to be able to bring this program to this community Absolutely and Kind of on the other side of things. I'm sure you're very aware that it's really hard to recruit specialty physicians And right now our nation is facing a shortage of all types of specialty physicians But even within cardiology, it can be difficult to find specialty cardiologists So what are some of your strategies that you're using to help recruit physicians in so that you have the right specialists at your center? Yeah, so I fundamentally it starts with building teams that kind of understand the needs of the communities We serve and the women we serve and then bringing together physicians with complementary expertise, right? So, you know, I mentioned a slew of programs that are sort of embedded under women's heart and one of the reasons we can do that is because we have diversity within our women's heart leadership So if you look at the leadership of our women's cardiovascular institute, Dr. Stadia, Dr. Reynolds and myself We each bring different areas of focus within cardiology and those niches are very complementary So when you combine those perspectives, it allows us to build a program that truly spans the full spectrum of cardiovascular care for women from prevention and risk assessment to complex and critical illness and equally important to that is the work we do do with other specialties and other colleagues It's not done in silo, right? Women's cardiovascular health intersects with many other specialties across the health system So we collaboratively we collaborate closely with our OBGYN colleagues or oncology colleagues Experts in lifestyle medicine and of course our primary care medicine colleagues also And I think that multidisciplinary structure is essential because women's cardiovascular health often unfolds across many Life stages, pregnancy, menopause, potentially cancer survivorship and so many other situations So when these specialties are all interconnected we can actually provide more coordinated thoughtful and patient-centered care Absolutely and I'd love to kind of go back to something you said at the beginning about how your service area has I think you said about 200 different languages that are spoken How are you meeting the needs for patients who don't speak English as a first language? Yeah so fortunately we have you know a lot of enslaved support services for example our translation services They're very very robust So we're able to you know sort of bridge the gaps in communication that way And we really try very hard to provide culturally sensitive care Particularly within our you know women's heart clinic where we've got so many different women speaking not only different languages But coming from different backgrounds different cultures bringing their diversity of pathology also So it's really important to be sort of culturally sensitive in our care delivery Absolutely now let's look a little bit to the future I'd love to hear two things from you the first is what is the next step for the women's institute? Yeah, I think this is only the beginning um, I think our existing pathways under the women's heart institute We would love to sort of grow those um, you know Whether it's the CPC ICU clinic or the breast cancer cardiac toxicity program our postpartum hypertension program We would actually love to expand these clinics and really that sort of our goal the next year to expansion um, but I think it's also a really exciting time right for Precision medicine technology. There's so much we can integrate into this women's cardiovascular program And this is really just a start Absolutely and kind of with that I'd love to hear your guess as to how you think specialized care By population might change in the next five years Yeah, I think there's a very timely question. I think we're entering a phase where specialized care will become more integrated More preventative perhaps it and definitely more data driven. I think we're going to see programs that move earlier in the disease timeline Right focusing more on the risk detection prevention rather than just Waiting until patients either present with an event or with advanced disease I think there will also be greater integration between specialties Cardiovascular care is increasingly intersecting with obstetrics oncology and technology critical care So I think this is really important especially as we're thinking about women's heart across the lifespan And across the spectrum of care and I think third technology is going to play a role in the future We're going to be using data digital health AI perhaps population-level analytics to identify patients who might otherwise fall through the cracks But at the end of the day, I think one thing that won't change or shouldn't change I should say is the core mission right equity and access to specialized care for women I just want to highlight that you know our program specifically I think it demonstrates that you know these sort of innovative population-focused cardiovascular care programs They don't have to exist only in the large academic centers right it can and it should exist in community hospitals and Public and municipal systems where the need is actually often the greatest and ultimately the goal is simple right making sure that that every woman and every patient, regardless of their background or circumstance, receives care it truly reflects their needs. - Absolutely. Well, this was been so amazing. I love carrying everything about what you're doing with your Women's Institute. So thank you for taking the time to share with us today and thank you to our listeners for joining us. - Of course, thanks for having me. (upbeat music)