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Timothy Henry, MD, discusses the transformation of STEMI systems of care
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In this issue, Timothy Henry, MD, MSCAI, director of the division of cardiology at Cedars-Sinai, talks with Cardiology Today about his roles in the early practice of interventional cardiology, the development of systems of care for STEMI and other emergency CV conditions and research in cell therapies for treatment of patients with HF or refractory angina.
Henry, a member of the Cardiology Today Editorial Board, received his medical degree from the University of California, San Francisco, in 1982. He then completed his residency at the University of Colorado Health Sciences Center, Denver, in 1985, and his cardiology and interventional cardiology fellowships at the University of Minnesota, Minneapolis, in 1990 and 1991, respectively, before spending 11 years at Hennepin County Medical Center.
In 2002, Henry moved from Hennepin to the Minneapolis Heart Institute, where he developed a network that dramatically changed the process by which patients with STEMI were treated. He is now in his third year running the division of cardiology at Cedars-Sinai.
Among other awards, Henry has been named to the Best Doctors in America list each year between 2007 and 2017, became a master fellow for the Society for Cardiovascular Angioplasty and Interventions in 2015, received the American Heart Association’s Heart and Stroke Hero Award in Research in 2013 and was granted the LUMEN Global Lifetime Achievement Award in MI in 2012.
Who has had the greatest influence on your career?
Dr. Henry: I’ve had key mentors at every level. My grandfather was a special man, a bigger-than-life guy, an entrepreneur and farmer who ran for governor of North Dakota. When I was about 15 years old, he died of MI at a time when there were no treatment options. His premature death had a major influence on my career choices. My father taught me to believe that anything is possible, a concept reinforced by my high school basketball coach which has motivated me throughout my career.
I had multiple cardiology mentors, but Robert Wilson, MD, the director of the cath lab at the University of Minnesota, played a special role. Bob was a skilled interventional cardiologist, an inventor and a great mentor who was probably the person who stimulated me to be an interventional cardiologist. Mentors have played a key role in my life, and I believe the opportunity to be a mentor to bright young physicians is a special blessing.
What areas of research in cardiology interest you most right now?
Dr. Henry: I’ve been involved with STEMI and systems of care for all acute CV emergencies. I am interested in a comprehensive approach to STEMI, including the process, the details of the procedure and the long-term follow-up, all of which influence the natural history of the disease.
My second major area of research is refractory angina. At the Minneapolis Heart Institute, we developed comprehensive prospective registries for both STEMI and refractory angina. The third area of research is regenerative medicine, in particular cell therapy, which overlaps well with my first two interests. Between Minneapolis and Los Angeles, we have now enrolled nearly 600 patients in CV stem-cell trials.
What advice would you offer to a student in medical school?
Dr. Henry: No. 1, medicine is an amazing career. There is such a wide range of opportunities available to us as physicians. Something they don’t necessarily teach us in medical school, but perhaps one of my greatest pleasures, is the opportunity to listen to patient stories. The unique intimacy we have interacting with patients and their families is a special privilege.
No. 2, remember your roots, where you grew up, your mentors, how and why you got to where you are now.
No. 3, take time to reflect; think about your goals, where you’re going next, what motivates you and why. We’re frequently so busy that we don’t take enough time to thoughtfully consider our pathway through life.
A few other key points: Find your passion, pursue excellence, be positive and finally be humble. As an interventional cardiologist, we have to be confident and make important decisions. But, almost every day, we see things we’ve never seen before — unique symptoms, unique findings, unique responses to therapy. It’s critically important to realize being a physician involves lifelong learning.
Have you ever been fortunate enough to witness or be a part of medical history in the making?
Dr. Henry: This has been a remarkable period of time to be an interventional cardiologist. When I graduated from medical school in 1982, it was not even a specialty. The first angioplasty was done in 1977 and I’ve had the privilege to witness the development of interventional cardiology over the course of my career with so many amazing breakthroughs, including angioplasty, stents and transcatheter aortic valve replacement.
For me personally it has been the development of systems of care for STEMI. When I was in medical school and in residency, there was no treatment for MI; we put people to bed and hoped they got better. For example, in the ISIS-2 trial published in 1998, one of the four regimens was placebo. It’s shocking to realize not that long ago we felt it was ethical to use placebo treatment for STEMI. The development of reperfusion therapy, fibrinolytics and then primary PCI has been amazing for the treatment of STEMI.
In 2002, I moved from Hennepin County Medical Center to Minneapolis Heart Institute. At the time, the DANAMI trial had not been published, but we believed primary PCI had unique advantages if performed in a timely manner. Bill Gates had a wonderful quote at the Harvard University commencement in 2007: “Humanity’s greatest advances are not in its discoveries, but in how those discoveries are applied ...” We developed a STEMI system to transfer patients from outside hospitals for primary PCI. Not just for emergencies, on a case-by-case basis, but routinely using a standardized protocol and integrated system. This first large STEMI network quickly grew to more than 30 hospitals and 10 clinics around Minnesota and Wisconsin up to 200 miles from Minneapolis treating 400 to 500 patients with STEMI per year. The results were far more successful than we could ever have hoped or believed; the benefits of primary PCI far exceeded mortality. The network has now treated more than 5,000 patients with STEMI and clearly has been the most important development in my career. I have the privilege of being involved in the development of the American Heart Association’s Mission: Lifeline program and have helped to develop regional STEMI systems around the world. The natural history of STEMI has been dramatically altered by this process — people like my grandfather now survive. We then applied the principles to all acute CV emergencies: out-of-hospital cardiac arrest, stroke, cardiogenic shock and pulmonary emboli.
What’s up next for you?
Dr. Henry: I’m very excited about the potential of regenerative medicine and I’m very involved with trials of stem-cell therapy for refractory angina and HF. I just became the chairman for the AHA’s Mission: Lifeline ACS committee and systems of care for all acute CV emergencies remain a passion for me. I’m starting my fourth year at Cedars-Sinai as chief of cardiology. Helping to lead an incredibly talented division is a unique opportunity. Finally, perhaps most important to me right now is our cardiology fellowship, the opportunity to train the next generation of CV leaders — a chance to pay it forward. – by Erik Swain