Practical Cardiology's Meet the Board: Guy Mintz, MD

Guy Mintz, MD

As Practical Cardiology continues to grow and looks to engage more clinicians involved in cardiology, we have also added members to our editorial advisory board. Our eyes and ears in the field, our advisory board members help guide coverage to position us to provide high-quality editorial content for cardiologists and clinicians practicing or with an interest in cardiology. To allow our readers, viewers, and listeners an opportunity to become better acquainted with our advisory board members, we are launching the Meet the Board series. Periodically, we will be spotlighting content focused on our advisory board members and the reasons why they were chosen to help lead Practical Cardiology as we look to expand our audience and solidify our position as a leader in cardiovascular news.

In this edition of Meet the Board, you will be introduced to our advisory board chief Guy Mintz, MD, Director of Cardiovascular Health & Lipidology at North Shore University Hospital. The following is a transcript from a recent episode of Inside the Practice on Medical World News where Mintz provided insight into how the New York City-based lipid clinic he co-directs adapted to the different stages of the COVID-19 pandemic.

Meet the Board: Guy Mintz, MD

PC: Could you take me through a little bit of what is different about how the lipid clinic had to react versus the rest of the hospital?

Mintz: I think that's a great question. Now, one of the challenges during pandemic was connecting with patients because patients were avoiding the physicians and avoiding the hospitals, but at the lipid center we were able to adapt pretty easily because part of what we do is being involved in counseling, dietary recommendations, and reviewing blood tests. I think one of the most important aspects of the service that we provided was that patients were still able to connect with physicians, nurse practitioners, and dietitians. So, they had a medical person to actually speak to, and a lot of the questions we were answering at that time were pandemic-related as well. In terms of the lipid center, we were able to send home blood draws out into the community, so patients were getting their blood done. Many patients were working from home, or a lot of patients had tremendous stress and anxiety and were overeating or eating poorly or not taking their medications on regular basis.

So, I think one of the great services we provided was connecting with those patients, and kind of keeping them on an appropriate pathway. We really didn't miss a beat. For those patients that did need a blood test, the home blood draws were very safe and secure. We were able to get those results and contact the patient and, if they needed, contact a dietician. Now, dietary intervention is very amenable to telehealth because here you have the dietician actually seeing the patient's home and many of the patients would hold up a box of food and say, "Is a cereal good," or "I bought this pasta", and “Look at my refrigerator". So, I think it was a great opportunity for patients to really be comfortable and get better advice or more advice along the way.

Many of these patients had issues with blood pressure. They were able to take their blood pressure at home and we're able to counsel them with regard to blood pressure. So, I think, as a unit, we adapted very well.

I think the continued connection with patients with regard to just having a medical persona, for them to run things by was very important. Because, you know, the whole, you know, initiation of COVID-19 was scary, there was no information, there was a lot of misinformation. And I think we provided a comfort role. And we certainly did not miss a beat in managing these patients. So, lipid problems and giving them guidance for appropriate dietary intervention.

PC: How did the way you guys reacted to this pandemic change as we learned more about COVID-19?

Mintz: Well, as we moved from December of 2019 right up till the end of February, we were not aware that we were facing a COVID challenge and that was really business as usual. Now, being in New York, which was the epicenter of COVID-19, at that time, everybody was going out to celebrate the Chinese New Year at the end of February 2020 and celebrate St. Patrick's Day in March of 2020. Then the following week, on March 22-23rd, there was a new term—we have a pandemic. We have a hidden disease or hidden infectious agent that's going to be potentially devastating, and everything changed at that moment.

My office personally was open every day during the pandemic. The staff alternated one group in one week and off the second week, and vice versa. Doing it this way, if any of them "got sick", it would not devastate the office. So, in terms of what we did, we used N-95 masks with a surgical mask on top, goggles or eye coverings, and gowns. In certain situations, we used gloves, and only the patient was permitted in the room. So, we didn't have family members in the room unless the patient requires assistance or mental incompetence and needed a second person in the room. We were trying to really space everyone out and limit the exposure early on.

So, that was one piece. We were really trying to stay as protected as possible. The pace was slower because we were really cleaning our rooms and spraying and wiping and doing more than we had done before. So, we weren't turning the rooms over as quickly and that was okay because the volume was not the same. Our patients had to fill out questionnaires asking about potential exposures and such. Wearing masks for the patients was a challenge. Sometimes they were amendable and sometimes they did not quite understand it.

Fast forward to where we are today and we still mask in our office, we still wear gloves, we still take precautions, and we still adhere to the guidelines. Patients should be masked as well, and we are still trying to keep only the patient in the room and not significant others unless it's absolutely necessary. Unfortunately, some patients, you know, in 2021, and we can say August 2021, refused to wear masks in the waiting room, which goes against hospital policy. There's some issue there, but things have changed after the vaccinations became available, but there is still a lot of misinformation regarding the vaccinations. Our team was vaccinated early in December of 20 and had our second dose was very early in 2021.

We are still vigilant in our infectious protocols and wiping down the rooms and everything else because as you there is a Delta variant and there's another gamma variant, and it's still out there and still could affect people. So, our vigilance hasn't changed. Our approach hasn't changed. We try to educate the patients. In any given week, I may see five or six patients that still do not want to get vaccinated and, while that remains their choice, some of their rationale is not correct. We try to educate them every bit of the way. We're still doing some telehealth, but I think after patients became vaccinated, they became less reticent about coming into the physician's offices.

PC: Is there anything else about you want to add about the lipid center’s response to COVID-19?

Mintz: Just as another highlight, going back to the spring of 2020 where patients really did not seek medical attention, you had an increased number of myocardial infarctions where patients were not going to the hospital—they were ignoring symptoms of chest pain and shortness of breath.

So, I think we lost a lot of life at that point because patients just did not want to go near a hospital or couldn't connect with their physicians. I think if we ever had to face that type of challenge again, education and connecting with patients should be a paramount goal to what we do. Not only at the local level between your own patient population, but in terms of news and media. Letting patients know, if you have these symptoms, it is safe to go to the hospital. If you have any questions, call 911, and so on, so forth.

Every pathway that we took through the pandemic was a learning opportunity for us, as medical professionals, on how to best reach our patients, how patients would react in these types of situations, and, moving forward, how we could do it better. I think that begins and ends with communication, being available, and taking the time to explain things. Education means power. I like to say whether I'm educating my medical students, my fellows, of my residents, we all need to row in the same direction. If we can't row in the same direction the boat is spinning in a circle and we go nowhere. So, I think that's really important for what we do on a day-to-day basis.

As you highlighted before, I still think that 2021 and 2022 will be the year of the lipid. as well, as we've talked before the COVID-19 virus as a lipid capsule, and I believe the monoclonal antibodies are housed in a lipid case as well. So, we can't get away from lipids and cholesterol, no matter where you go. It's not just at Wendy's and McDonald's, but it's all over and patients need to understand that as well.

I think is important, not only for our clinicians but also for our patients, that very simply, patients that do get COVID-19 and have ongoing symptoms—the so-called group called the long-haulers. While many people are out there and say, "Oh, this is a benign thing. It's a three-day cold". Listen, we've seen 100 patients post-COVID with ongoing chest pain, ongoing shortness of breath, and I have many patients that have brain fog. So, even getting COVID and surviving and doing well, it doesn't leave patients necessarily as healthy as when they started. The post-COVID syndrome or long-haul syndrome is real, it affects many, and there are patients still from March of 2020 that still have the loss of sense of smell and loss of taste. So, I think that's also an important factor to highlight to the general public who need to know that it's not a one-and-done thing. It has certain consequences; the more cardiac risk factors someone has the greatest susceptibility they have to COVID-19 and COVID-19 could have deleterious effects. It's an all-encompassing virus and I think we need to be vigilant.

Editor's note: This transcript has been edited for length and clarity.