Many nurses go into the profession with the hope of making a difference, and Michele Santoro, RN, is one of them. Inspired to the heart and vascular specialty after her father experienced a heart attack during her college years, she has been a stalwart at the Yale New Haven Hospital Heart and Vascular Center in North Haven, Connecticut for more than a decade. Santoro is a shining example of bringing a human touch to the fast-paced, tech-driven world of cardiac nursing, and changing patients’ lives in the process.
Named the 2022 National Magnet Nurse of the Year, Santoro was recognized for her innovative approach to cardiac care. Specifically, she identified a serious issue affecting thousands of cardiac patients, who were disconnected from a monitoring device platform after a software vendor performed an update. She also helped to build the remote monitoring clinic at YNNH and standardize the database that captures potentially life-threatening arrhythmia in thousands of patients in the region.
Learn how Santoro is making a difference in cardiac care, and her perspective on the opportunities for nurses within the specialty.
Creating a Remote Monitoring Clinic
At device clinics, nurses and other clinicians monitor and manage implanted cardiac devices, including pacemakers, implantable loop recorders and defibrillators, for patients with conduction system disease. Prior to Santoro implementing the device clinic, preventing patients from potential complications was a challenge.
“We were able to start a standardized platform that monitors all our patients remotely,” she said. “We had 2,100 patients that were lost to follow up, but now we have almost 7,500 patients being remotely monitored. The technology we have is keeping patients safe.”
Here’s how: Santoro and her team remotely monitor patients, and if abnormal activity is detected, they triage – either directing them to an outpatient clinic for IV diuretics to prevent readmission, or to the emergency room for more serious episodes.
The database found potentially life-threatening arrhythmias in 47% of enrolled patients, 45% of whom required medical and surgical treatments.
“I’m seeing remotely that a patient had a [heartbeat] pause, and I’m calling that patient saying, you need to go to the hospital. These patients can come to the clinic and get the care they need, and we’re making that happen really fast,” Santoro said.
That speed is essential because, as those in the cardiology field often say, ‘time is muscle.’ It means that the severity of cardiac injury can be lessened the faster intervention occurs.
Researching Better Outcomes for Implantable Heart Recording Devices
Currently, Santoro and two nurse colleagues are working on research related to implantable loop recorders, which are used to monitor abnormal heartbeats, often in patients who have recently had a stroke. It’s a small recorder, about the size of a paper clip, and it’s implanted into the chest to detect atrial fibrillation or other abnormal rhythms.
Sometimes, Santoro says, neurologists and other providers may feel that after six months or a year, there isn’t a need to further monitor patients who haven’t experienced ‘afib.’ But the device is good for up to four years.
“In my study,” Santoro said, “I’m finding people with atrial fibrillation two or two and a half years later, and if they weren’t monitored, we wouldn’t know, and then they may have another stroke.”
Santoro has collected nearly 10 years of data on the implantable loop recorders, to determine how many patients discover abnormal heartbeats after the typical monitoring period. She is also expanding the project's scope to include ethnicity and determine the benefit of different interventions and treatment plans to facilitate the best and most equitable outcomes for patients.
The Power and Potential of Cardiac Nursing
For Santoro, one of the most impactful moments of her job is finding answers to patients’ medical mysteries.
“Maybe a patient fell and hit their head, or had a stroke, and we didn’t know why. I monitor for weeks or months and guess what – I find a 6-second pause,” she says. “That patient goes to the hospital, gets a pacemaker, and we’re going to hopefully prevent you from ever having another one. There’s the answer. It’s that empowering.”
It’s also a fast-paced and always-evolving specialty, with new research, innovation and technology.
“It’s one of the biggest fields in medicine and growing so rapidly,” she said. “Whether it’s the plumbing part of the heart or the electrical part of the heart, it’s moving at such a fast speed. It’s a really fun area to be in.”
Learn more about becoming a cardiac care nurse.
