Improving Care, Expanding Services, and Fostering Transitions for ACHD Patients

Arvind Hoskoppal, MD, MHS, joined the Heart Institute at UPMC Children’s Hospital of Pittsburgh in 2019 as the new director of the UPMC Adult Congenital Heart Disease (ACHD) program. Dr. Hoskoppal’s clinical area of expertise is pediatric cardiology, with a special focus on ACHD, advanced echocardiography, including transesophageal echocardiography, and aortopathies. Under his leadership, the UPMC Adult Congenital Heart Disease program is set to expand its scope of services and its ability to reach and care for an ever-growing and thriving patient population with various forms of congenital heart disease.

An Expanding Patient Population With Long-Term Needs

Decades of advances in pediatric cardiology and cardiothoracic surgery have produced an ever-growing population of adults living long, relatively normal lives with various forms of adult congenital heart disease.

“If you consider the population of the United States as a whole, there are now more adults living with Congenital Heart Disease (CHD) in the country than there are children with CHD. That is an extraordinary testament to the progress we have made in treating these complex disorders,” says Dr. Hoskoppal.

However, the growing population of CHD patients surviving into adulthood requires lifelong, complex cardiac care. Meeting the needs of this patient population means expanding services, developing new models of care, and introducing technological advances to lower or remove barriers to care. The UPMC Adult Congenital Heart Disease program is rising to the challenge with a multifaceted approach.

A Multidisciplinary, Tri-Campus Model of Care

“The number one goal for me as the leader of the ACHD program is to improve access to care for our expanding patient population,” says Dr. Hoskoppal.

The ACHD program operates on a unified, tri-campus model with UPMC Children’s, UPMC Presbyterian, and UPMC Magee-Womens Hospital serving as the hubs for clinical care for the entire spectrum of ACHD patients — younger or older, male or female.

Collaborations with the UPMC Heart and Vascular Institute and cardiology practices across the UPMC system, and outreach to regional and community cardiology providers for referral needs and support are hallmarks of the program.

“Our goal is that any new patients referred to the program, either from practices inside our system or from external providers, are seen within the two-week benchmark timeframe we have as a system. It is critical to get new patients into the clinic for evaluation without having to endure long waits. Improving access means, in part, faster service,” says Dr. Hoskoppal.

Transition of Care

Another aspect of improving patient access occurs during the transition period when younger, teenage, or adolescent patients are ready to move out of pediatric care and into adult care. Abrupt changes or drop-offs in care, without a formalized process and handoff in place, can lead to disruptions in patient care and a decreased level of satisfaction, among other concerns.

For this reason, Dr. Hoskoppal and colleagues are in the process of developing a rigorous, formal transition program for these patients. Because Dr. Hoskoppal is dually associated with the Heart Institute at UPMC Children’s and the UPMC Heart and Vascular Institute, his work in developing the formal transition program can be likened to being a bridge-builder between the two entities to facilitate and optimize how and when patients are moved from one care dynamic to the next in a seamless fashion.

ACHD and Pregnancy

An important aspect of the UPMC ACHD program deals with adult women with ACHD who desire to become pregnant and start or add to their family. Navigating and caring for female ACHD patients during pregnancy is a challenging endeavor, and requires specialized services and a multidisciplinary approach to manage this complex care dynamic.

“Guiding our pregnant ACHD patients safely through their pregnancy necessitates close collaboration with the maternal-fetal medicine (MFM) specialists at UPMC Magee. This is another aspect of how our tri-campus model functions to optimize patient care. Our UPMC Magee colleagues and the services available at that hospital mean we need not duplicate those services at UPMC Children’s,” says Dr. Hoskoppal.

Preconception counseling for women with ACHD who desire to become pregnant is a critical component of the program. Having a form of ACHD predisposes both mother and fetus to various risks.

“There are, of course, risks to the mother and baby during the pregnancy related to the mother’s underlying condition. We counsel on these potential complications, and we also can counsel on any underlying genetic conditions that may be at the root of the mother’s ACHD and potentially could be passed on to a child,” says Dr. Hoskoppal.

24/7 Consultative Services for Hospital Admissions

New to the UPMC ACHD program is a 24/7 consultation service for any patients admitted to the hospital for care of another condition or surgery, or for any ACHD patient who arrives through the emergency department for any reason.
 
“For any ACHD patient who makes their way to the hospital, we have put in place a formalized process for consultations. For example, if an ACHD patient is admitted for gallbladder surgery, or a patient has a traumatic accident or injury, our team is available round the clock to consult and advise on their care relative to their underlying ACHD,” says Dr. Hoskoppal. “We want our colleagues across the hospital and our patients to know that no matter what kind of care they are receiving, we are right there to support them and the team.”

Patient Referrals and Additional Information

Referring physicians can contact the UPMC Adult Congenital Heart Disease program at 412-692-3158 or by email at achd@upmc.edu.

UPMC Adult Congenital Heart Disease Program Members

• Arvind Hoskoppal, MD, MHS
       Director, Adult Congenital Heart Disease Program
• Jacqueline Kreutzer, MD, FAAC, FSCAI
       Chief, Division of Pediatric Cardiology
       Medical Director, UPMC Children’s Heart Institute
• Victor Morell, MD
       Surgeon-in-Chief, UPMC Children’s
       Chief, Division of Pediatric Cardiothoracic Surgery
       Co-Director, UPMC Children’s Heart Institute
       Co-Director, UPMC Heart and Vascular Institute
•  Samir Saba, MD, FACC
       Chief, Division of Adult Cardiology
       Co-Director, UPMC Heart and Vascular Institute
• Ashley Draxinger, RN, BSN – RN Coordinator
• Juanita Godfrey
• Morgan Hindes – Research Coordinator
• Patricia Rigby Hovanec, CRNP
• Vanessa Kowalski, MSN, CRNP
• Robin Telles, MSW, LSW
• Lori White, RN
• Michele Zanotelli

More About Dr. Hoskoppal

Dr. Hoskoppal graduated from MS Ramaiah Medical College, Bangalore University, India, in 2002. He then pursued a master’s degree in Health Finance and Management from Johns Hopkins University, which provided Dr. Hoskoppal advanced training and skills in the area of health care management. Next he completed his residency in a combined internal medicine-pediatrics program at Creighton University Medical Center in Omaha, Nebraska, followed by a pediatric cardiology fellowship at the University of California San Francisco Medical Center. With interest in adult congenital heart disease, Dr. Hoskoppal further subspecialized, completing an ACHD fellowship at the Mayo Clinic in Rochester, Minnesota.

Upon completion of his training in 2014, Dr. Hoskoppal joined the Division of Pediatric Cardiology at the University of Utah as an assistant professor of pediatrics, with an adjunct appointment in the Department of Internal Medicine. In 2015, he was appointed the director of the University of Utah ACHD program, having become a national leader in the field.