New Cardiology Faculty

The cardiovascular medicine division has added two new faculty members, both of whom have skills that complement and supplement those of the rest of the division. Both Nitish Badhwar, MD, and Fatima Rodriguez, MD, MPH, have hit the ground running and are greatly enjoying their challenges and accomplishments.

Nitish Badhwar is busily settling in as clinical professor of cardiovascular medicine. “I came to Stanford in part because of my expertise in ablating complex cardiac arrhythmias, particularly catheter ablations of ventricular tachycardia, and in part because of my interest in leading a fellowship program to develop future electrophysiologists. There is no shortage of patients with challenging arrhythmias, and the fellowship program will soon be expanding.”

One obvious reason for the growth in the arrhythmia population is the success cardiologists have had in treating other heart conditions. “In cardiology we have increased the lifespan of patients through drug therapy and preventive cardiology,” says Badhwar. “As patients who might have died in their sixties are now getting older, they are developing arrhythmias that affect their quality of life.”

Stanford has a large heart failure population and a very busy cardiac transplant center; the first U.S. adult heart transplant was completed at Stanford 50 years ago. For those who cannot qualify for a heart transplant, there are other options, including left ventricular assist devices (LVADs), which help with the pumping function of a weakened heart, and bi-ventricular implantable cardioverter defibrillators (ICDs), which are internal devices that stop deadly arrhythmias by delivering a shock to the heart.

“Most patients with severe heart failure have ventricular tachycardia,” explains Badhwar, “and that leads to shocks from ICDs or makes LVADs less efficient. Ultimately, the ventricular tachycardia (VT) has to be treated, but medications are not that effective. We often end up taking the patient to the electrophysiology lab to eradicate the ventricular tachycardia by ablating it when possible.”

Another of Badhwar’s interests is idiopathic VT, where patients have normal heart function as opposed to heart failure. Badhwar has published the characteristics of idiopathic VT arising from the crux of the heart and, he says, “for this arrhythmia I am collaborating with my colleague, Marco Perez, MD, assistant professor, on a research project to identify the culprit genes.”

Badhwar has had a great deal of experience with atrial fibrillation (Afib), an increasingly common arrhythmia that puts patients at risk of stroke from blood clots that arise in the atrial appendage. While at UC San Francisco, he helped develop and publish a new technique to control the rhythm of the heart in patients with persistent Afib. This technique uses a catheter-based approach through a vein in the leg to tie off the left atrial appendage. A multicenter clinical trial called the aMAZE trial is currently testing the technique. “The trial is very near and dear to my heart,” says Badhwar. “Stanford is recruiting patients now.”

Leading a Fellowship Program

The fellowship program for electrophysiology (EP) trainees plays a large role in Badhwar’s work. “Because I had enjoyed training EP fellows at UCSF, I wanted to develop the electrophysiology training program here. One of my passions is teaching fellows, and it’s been very satisfying for me since I’ve been here. At UCSF I worked with Dr. Melvin Scheinman, one of the pioneers in this field, and I was very proud to use unique training tools such as teaching anatomy using cadaveric hearts in collaboration with pathology. I’ve also started intracardiac conferences for EP fellows and a national cardiology EP fellows program.”

The EP training program is also likely to expand because, says Badhwar, “It is clear that we are going to be doing more complex and novel procedures. My focus will be to make Stanford a magnet for US and international fellows for world class electrophysiology training.”

The influences in Fatima Rodriguez’s life began early. A child of immigrants, she was raised by a single mother who developed a pivotal illness: “My mom had rheumatic heart disease discovered when I was 15. I wanted to be just like her cardiologist who had made a life-changing diagnosis with just the use of his stethoscope.” Additional influences came her way at Harvard Medical School, where she arrived wanting to “just be a good clinical doctor.”

“There I had wonderful mentors who opened my eyes to public health research as well as taking care of individual patients. I received a Zuckerman Public Policy Fellowship in the John F. Kennedy School of Government, where I got to work with people across such sectors as business and law with a common goal of improving parts of health care that are not related to the medical system.”

Today, Rodriguez is a new assistant professor in the cardiovascular division with a particular interest in health disparities and improving cardiovascular risk prediction for understudied populations. As a general and preventive cardiologist, she encounters her research subjects at every clinic and during each two-week period of inpatient care. “My clinical work always influences my research questions,” she says. And, with 75 percent of her time devoted to research, she is able to think broadly about, and often test, new approaches to improving the health outcomes of her patients.

As a general cardiologist in a tertiary care center, Rodriguez works on the general cardiology service as an inpatient consultant and as part of a team that includes residents and medical students. She also has two weekly clinics: “I have an outpatient clinic in prevention focusing on risk factor control and risk assessment, and I see patients with advanced lipid disorders. I also have a general cardiology clinic, where I have a particular interest in caring for Spanish-speaking patients, since limited English proficiency directly impacts patient health and adherence.”

Dealing with patients’ medications is often a challenge. She explains: “In cardiology we have many very wonderful medications, and most of them are generic and therefore cheap and readily accessible. But they can’t work if you don’t take them. I often struggle with patients about their resistance to taking statins, which unfortunately get such bad press. I have a deal with my patients where I usually don’t start a new medication without taking something else away.”

Taking on Telemedicine

Proximity to Silicon Valley has had an effect on Rodriguez as well.

“I am the research director of our telemedicine clinic, which is called CardioClick. We are piloting it in the Stanford South Asian Translational Heart Initiative (SSATHI), a program designed for South Asians because of their higher risk of heart and vascular disease than any other ethnic group. Once CardioClick shows that it helps the SSATHI population understand their risk factors and develops targeted treatment plans for them, we will expand the services to the rest of preventive cardiology. We want to show not only that it’s convenient, because our patients can access us on the computer or iPhone, but also that it improves clinical outcomes. We’re also tracking patient satisfaction and engagement, factors that are important for the expansion of the program.”

Having had wonderful mentoring throughout her early career, Rodriguez naturally drifted toward passing it forward. “What is becoming important to me now is mentoring others,” she says, “especially underrepresented minorities and women. I hope to be able to continue to support people in that way.”