Critical Care and Hospitalist Neurology

NeuroCardiac Comprehensive Care Clinic (N4C)

Why see a neurologist after a heart condition?

Thanks to advancements in critical care during the last decade, cardiac arrest diagnosis and intervention occur earlier. As a result, treatment is more successful today than ever before. Although survivorship has increased, many people remain debilitated due to varying degrees of neurocognitive and psychosocial problems.

  • Two-thirds of cardiac arrest survivors suffer from cognitive deficits, particularly memory, planning, problem-solving, and attention
  • Two-thirds experience anxiety and depression
  • One-third develop post-traumatic stress symptoms
  • Nearly all complain of severe fatigue and low life satisfaction
  • Only half of them ever return to work

A quarter of cardiac arrest survivors develop seizures and/or stroke during their hospitalization and need continual neurological care and monitoring of their medications up to one year after discharge.

The care-givers of these survivors experience similar psycho-social disturbances leading to an overall reduction in quality of life.

We believe that cardiac arrest survivor is truly a “Cardiac” and a “Brain-injured” survivor.

Early diagnosis and appropriate systematic interventions have resulted in better long-term outcomes including cardiovascular mortality, depression/anxiety rates, self-management & coping strategies, health & disease education, physical symptoms, faster return to work and overall quality of life.

As a response to this, we have created a comprehensive, dedicated NeuroCardiac Clinic to systematically follow and manage cardiac arrest survivors with complex issues. The goal is to promptly identify and address any neurocognitive/neurological complications and psycho-social problems that may occur to minimize disability in both the short- and long-term, and help re-integrate them into the community.

Additionally, research on recovery after brain injury due to cardiac reasons is still growing - our group, with your assistance, is very committed to learning and sharing novel treatment options including rehabilitative, pharmacological, or biofeedback methods.

For more information about the NeuroCardiac Comprehensive Care Clinic or to schedule an appointment, please call 212-305-4234.

Vision & Mission Statement

The NeuroCardiac Comprehensive Care Clinic at NewYork-Presbyterian/Columbia University Irving Medical Center is the first of its kind in the nation.  It is a “One-Stop Shop” that offers comprehensive, multi-disciplinary, well-coordinated care for survivors of cardiac arrest who can participate in an in-person dialogue with our team members and attend scheduled clinic visits.

Services include:

  • Early screening and detailed cognitive evaluation with development and implementation of novel cognitive rehabilitation strategies to those affected
  • Early screening and detailed psychiatric evaluation, treatment, and monitoring by an expert neuropsychiatrist
  • Treatment and monitoring of various neurological complications after cardiac arrest including adjustment of seizures, spasticity, and other neurological medications by a team of experts
  • Education and assistance in the form of support groups for patients and their caregivers

The goal of this program is to help each cardiac arrest survivor reach his or her full potential. 

For more information about the NeuroCardiac Comprehensive Care Clinic or to schedule an appointment, please call 212-305-4234.

Providers

Our multidisciplinary team consists of specialists from various fields:

Neurocritical Care 

Sachin Agarwal, MD, MPH, founder of the NeuroCardiac Clinic, is a neurologist with specialization in neurocritical care. He is involved in the acute care of these survivors from their admittance to the hospital through inpatient recovery and discharge, and will continue the overall coordination of their care in the NeuroCardiac Clinic. Dr. Agarwal's expertise lies in monitoring and studying, in detail, the cognitive trajectories of survivors within the first year of recovery, when their treatment is most modifiable, through either cognitive rehabilitation or pharmacological methods. In collaboration with his colleagues in the Divisions of  Cognitive Neuroscience and Neuroimmunology, Neuroimaging, and the Center for Behavioral Cardiovascular Health, Dr. Agarwal aims to define, predict, and estimate factors affecting cognitive deficits and its recovery trajectories in survivors of cardiac arrest. 

Neuropsychology

Marykathryn A. Pavol, PhD, ABPP is a board-certified neuropsychologist with expertise in brain injury rehabilitation program coordination (inpatient and outpatient), as well as cognitive and neurobehavioral assessment for a broad range of medical diagnoses.  For survivors of cardiac arrest, she has provided the design of neuropsychological exams to evaluate cognition, mood, and quality of life. She also supervises the training of neuropsychological test administrators and is responsible for the scoring and interpretation of test results. 

Alexander M. Presciutti, BS is currently in training as a clinical psychologist at Columbia University, with a focus on research methods, health psychology, and neuropsychology. In the NeuroCardiac Clinic, he is involved in the administration of neuropsychological assessments and screening tools for psychiatric disorders. Alex has a particular interest in researching ways to effectively improve cardiac arrest survivors' long-term psychiatric sequelae, such as post-traumatic stress symptomatology. 

Pastoral Care 

Chaplain Linda S. Golding, MA, BCC is the Coordinator of Pastoral Services for NewYork-Presbyterian/Columbia University Irving Medical Center.  Her expertise lies in providing multi-faith spiritual and emotional support to patients and families, with a strong focus on resilience.  As a member of the NeuroCardiac Clinic team, Linda guides patients and families on developing coping strategies against the negative impact neurological and psychiatric manifestations can have on their daily lives and relationships. 

We work very closely with rehabilitation & regeneration specialists and cardiologists to create a well-coordinated plan for each individual survivor.

Other relevant ancillary services that are provided on site include:

  • Phlebotomy
  • Imaging: MRI brain (compatible with Automatic defibrillators), PET scan
  • EEG both routine or ambulatory

Location

The Neurological Institute of New York
710 West 168th Street, 3rd Floor
NewYork-Presbyterian/Columbia University Irving Medical Center
New York, NY 10032

  • Our specialists are embedded in one location to promote seamless care coordination
  • Our patient waiting rooms are easily accessible and can accommodate those with physical handicaps
  • Appointments are structured to ease the burden of seeing multiple specialists: instead of moving from office to office, patients at the NeuroCardiac Clinic remain in one room and our specialists come to them

Together, the NeuroCardiac Clinic team creates an individualized care plan tailored to each patient’s unique needs. Special attention is paid to cognitive, neuropsychiatric, and occupational therapy needs, all of which contribute to a patient’s ability to function at home and in society. 

The process of recovery is dynamic and may continue for months following the arrest. We believe that early interventions can lead to a fast return to work, address emotional distress, improve overall quality of life, and decrease cardiovascular mortality, even for patients who have mild-to-moderate cerebral dysfunction.

The program also plans to run support groups for patients and their caregivers to share experiences and advice.

For more information about the NeuroCardiac Comprehensive Care Clinic or to schedule an appointment, please call 212-305-4234.