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June Newsletter



Quarterly Meeting

Over 40 members attended Our summer quarterly meeting.  Read this edition of our newsletter for meeting highlights.


Dr. Shor welcomed attendees and offered hopes for moving towards in-person meetings in the near future as COVID comes into better control.

The group was updated on the various projects/forums taking place with the collaborative.

Angiogram Film Reviews (MACPAQ):  Two centers are currently piloting the enhanced program.   Favorable remarks have been received thus far.  Data will be presented at the Fall meeting.

AKI Workgroup:  Recommendations are underway for better renal control as we await the release of the STS AKI Guidelines.

Shock Management Workgroup:  To date 22 responses have been received on the statewide survey to assess current shock management strategies.  A proposal to host a shock-focused meeting will be presented to the Board in July.

Healthcare Disparities: We are in the early stages of forming a Healthcare Disparities Workgroup.  The Champions of this work group are David Wyatt, MD (Carilion), Dr. Ramesh Singh, MD (Inova) and David Reich (Inova).  A survey was designed to get a consensus of what practices are taking place within your member organization.  Please take a moment to complete the questionnaire at: https://www.surveymonkey.com/r/VCSQIHCD


Database/Registries:  With VHAC as a strategic partner, our goal of creating a statewide STEMI database is still underway. ARMUS will serve as the data warehouse for this joint registry. 

TVT:  The process has been slow but we recently received an email announcing that the data specifications will be released soon.  VCSQI remains cautiously optimistic as we move forward and hope to present data by the Winter Quarterly Meeting.

Financials:  While this has been a strange year for all of us, our finances have been more flexible in order to move with the times.  Some of our expenses are less because we’re meeting remotely.   Fiscals remain sound and we continue to meet our goals and objectives.

VCSQI Database Updates and Angiogram Review Results

Eddie Fonner gave a sneak peak of preliminary STEMI data.  Ideas for additional representations of data and metrics were discussed in detail.  

Blinded data was shared focusing on PCI as well as STS by member program. 

Data related to the enhanced angiogram film reviews with MACPAQ will be presented at the Fall meeting. 


featured presentation

Atrial Fibrillation: Medical Therapies, Catheter Ablation, and Surgical Techniques

Dr. Brett Atwater (Inova) provided an overview of the recent changes in medical and procedural management of atrial fibrillation.  Two important points were highlighted:

1.  Changes in anticoagulation guidelines, which came out with the update the consensus statement for a fair management in 2019. 

2.   The use of rate control vs. aggressive rate control – recommendations released in 2006. 

To provide insight from a surgical perspective, Eric Sarin, MD (Inova) highlighted the work of Jim Cox as a key contributor to surgical treatments of A-fib.    

Brett Atwater, MD

Dr. Brett Atwater joined the Inova Heart and Vascular Institute as the Director of Electrophysiology and Electrophysiology in December 2020.

He graduated from the University of Chicago Pritzker School of Medicine and completed his internship and residency at Duke University.  Dr. Atwater completed his general Cardiology Fellowship at the University of Wisconsin, Madison before returning to Duke for subspecialty training in clinical cardiac electrophysiology.  After his completing his training, he joined the faculty at Duke as an Instructor and also served as the Director of Electrophysiology at the Durham, VA hospital.  He subsequently assumed the role of Director of the Electrophysiology Labs for Duke and was an Associate Professor of Medicine with tenure.

Dr. Atwater authored over 75 publications and is the primary investigator in several active grants and his research interests are in cardiac resynchronization therapy and atrial fibrillation  

Eric Sarin, MD

Eric Sarin is the Section Chief for Cardiac Surgery at Inova. 

He is a recognized authority in the treatment of micro valvular disease and atrial fibrillation, particularly through minimally invasive approaches. 

Dr. Sarin is a graduate of the University of Michigan and received his medical degree at George Washington University School of Medicine.  He later obtained training in general surgery and surgical critical care at the University of Colorado.  He completed his cardiothoracic training at Emory.  He moved on to received a degree in Tropical Medicine from the London School of Tropical Medicine and Hygiene with the Royal College of Physicians. 

AKI Workgroup

Mike Brown, CCP, co-Champion of the AKI Workgroup gave a presentation that gave a overview of the group’s current efforts that includes:

  1. Standardize post cath kidney function testing
  2. Hemodynamic guided hydration protocol
  3. Pre/post cath and surgery discontinuation of nephrotoxic medications
  4. Standardize guidelines/recommendations for nephrology consult
  5. Intra-Op management: Anesthesia/Perfusion considerations

The group plans to review the STS AKI guidelines which is slated for release later in 2021.


The Perfect Care Collaborative

Dr. Kevin Lobdell expressed excitement as the VCSQI/Perfect Care Collaborative Network begins to take shape.  The group has begun reviewing high level summary data of both collaboratives.  

WakeMed has joined the network and Perfect Care now averages between 650 to 700 cases a year.  New prospects include Navicent in Georgia. 

Additional opportunities are forthcoming that allow for the sharing of cost data as well as best practices for targeted initiatives such as AKI and Goal-Directed Therapies. 

What VCSQI initiative or workgroup are you most interested in?

Attendees at the recent Quarterly Meeting showed a diversity of interest via an interactive Zoom poll.  There is still time to join one or more of our exciting efforts. 

Below are a few quick updates from our workgroups that were not discussed at last week’s meeting. 


The Enhanced Recovery Workgroup has taken a new direction.  VCSQI thanks thanks Dr. Kevin Lobdell and Bethany Sarosiek for their continued help and support.  The Enhanced Recovery Workgroup will redirect its efforts by developing a resource site and mentorship program with efforts to highlight those who have impletemed ERAS guidelines and serve as a boutique of resources to support those seeking input and/or guidance. 

More to come. 

Research & Writing

The Research and Writing Committee is excited to highlight the following research projects:

  • The Relationship of the Distressed Communities Index and Access to Coronary Revascularization
  • Reduction in Acute Kidney Injury Following PCI by Use of Radial Artery Access
  • Postoperative Atrial Fibrillation Is Associated with Increased Resource Utilization After Cardiac Surgery
Perfusion Group

The Perfusion Group continues to increase its membership and remains diligent in recruiting one perfusionist from each member organization.  The group established subgroups to provide recommendations on the following:

  1. Integration with EMR 
  2. Goal-Directed Therapy 
  3. AKI