In the 1960s and 1970s, Grady Memorial Hospital was the major teaching hospital of Emory University’s medical school, such that most of the students and medical residents (and subsequently subspecialty residents and/or fellows) were based at Grady. With Dr. Willis J. Hurst as both Chairman of Medicine and Chief of Cardiology, a great deal of attention was focused on the rapidly burgeoning specialty of cardiology.
With the expanding capability to broadcast medical education on TV, Grady’s auditorium became the site for about 20 hours of medical educational television each week, much of it related to cardiology and medical grand rounds. Programs were transmitted to every hospital of more than 200 beds in the state of Georgia, under the auspices of the CDC’s Dr. J. Gordon Barrow.
Dr. Nanette Wenger was appointed director of the Cardiac Clinics in 1960. Within the Cardiac Clinics, one of the first cardiology patient education programs was developed – initially using booklets on rheumatic fever, rheumatic heart disease, heart failure, hypertension, low sodium diet and other concerns and subsequently using video recordings for presentations by physicians, nurses, dietitians and others to patients during their visits to the clinic.
The Clinic used the stick-figure icons “PAT” and “ED,” eponyms for patient education to provide teaching at Grady. Within the Cardiac Clinics, one of the earliest anticoagulation clinics in the U.S. was established, providing Coumadin education to patients and recommendations for dosage to physicians. An algorithm was devised to order Coumadin dosages based on the prothrombin time (and subsequently the INR).
The education and prescription components were controlled by nurses in the then “Coumadin Clinic.” Over the years, the Grady Coumadin Clinic became one of the largest Coumadin clinics in the U.S. and contributed substantially to the subsequent Anticoagulation Forum.
The Cardiac Catheterization Laboratory was established in 1962 at Grady by Dr. Robert Schlant, with the early procedures involving predominantly diagnostic studies for congenital heart disease and rheumatic heart disease, although it served as the focus for studies on pericardial effusion and on atrial myxoma. The Coronary Care Unit, one of the earliest in the nation, opened in the 1960s, headed by Dr. Dan Arensberg and Dr. Joel Felner.
In 1966, based on a Federal grant from the Social and Rehabilitation Services of the U.S. Department of Health, Education, and Welfare, Dr. Wenger became Director of a Program for Cardiac Evaluation and Medical and Vocational Rehabilitation, which continued from 1966 through 1990. It was the first federally funded programs available following the successful desegregation of Grady.
Within this program, Dr. Wenger was joined by Dr. Mary Skorapa from Physical Medicine and Rehabilitation and Dr. Charles Gilbert, a cardiologist who had a major interest in exercise physiology. The group initiated the first Early Ambulation Program after Myocardial Infarction worldwide, with the Grady 21-step program (subsequently abbreviated to 14 and then 7 steps) used as a model globally. Also established was one of the earliest outpatient Cardiac Rehabilitation programs, providing exercise training to patients after myocardial infarction and in subsequent years following coronary artery bypass graft surgery.
In 1968, Grady established the Holter Laboratory (subsequently renamed the Ambulatory Electrocardiographic Laboratory) using primitive diagnostic equipment first developed by Norman Holter. For over a decade, the use of this equipment was demonstrated at the annual American Heart Association Scientific Sessions, evolving from a huge tabletop tape-based device into the miniaturized versions in use today.
With the advent of cardiac pacemakers, Grady developed within the Cardiac Clinics a program for the identification of cardiac pacemakers by radiographic imaging characteristics (published in The New England Journal of Medicine), a procedure necessary when patients from around the world arrived at Grady. In so doing, physicians knew some of the characteristics of their early-year implanted pacing devices. This unit subsequently evolved into the contemporary Device Clinic with sophisticated interrogation of both pacemakers and ICDs.
The Exercise Testing Laboratory (primarily treadmill exercise testing) evolved contemporaneously with the cardiac rehabilitation program and subsequently transitioned to a joint laboratory with radiology that also involved imaging studies. Dr. Joel Felner was involved in the establishment of the Echocardiographic Laboratory – initially using M mode echocardiography. The huge machines presented a challenge to transport around the hospital and with time evolved into the sophisticated system of 2D and now 3D echocardiography used today.
With the arrival of Dr. Peter Symbas at Grady in 1974, cardiac surgery began at the hospital – however, there was only a single cardiopulmonary bypass unit available within the total Emory University system; Dr. Charles Hatcher would load the equipment onto a truck and drive it to Grady so that he and Dr. Peter Symbas could perform early cardiothoracic surgery procedures, a process that evolved substantially over the years. Because of the enormous trauma volume and experience at Grady, Symbas published what remains today the classic volume on Cardiac Trauma Surgery.
The problem-oriented medical record, developed by Dr. Larry Weed at Vermont, was pioneered at Grady Memorial Hospital under the direction of Dr. J. Willis Hurst. This included a Problem List in the front of each paper chart and the format of each of the problems listed as S, O, A, and P – subjective, objective, assessment and plan. It is noteworthy that this formulation provided the basis for the current electronic medical records now universally employed.
Additionally, The Heart, then the standard multi-author textbook of cardiology, was conceived and developed on the Grady campus in the Glenn Building, with Drs. Hurst, Logue, Schlant and Wenger editing the first several editions. Now in its 14th edition, it remains one of the foremost textbooks in cardiology.
Grady Memorial Hospital was also the site of a very intense cardiovascular research program, with patients enrolled in multiple multicenter clinical trials funded by the National Institutes of Health (NIH), subsequently the National Heart, Lung and Blood Institute (NHLBI), and then by industry. Many of the findings formed the basis for contemporary cardiac care.
Dr. Wenger was the Principal Investigator or Co-Principal Investigator with Dr. Robert Schlant on most of these studies. The original research project (1970-1973) was the NIH-Emory Sudden Death Project on Stadium Coronary Care. Grady established a CPR unit at the then newly opened Atlanta Fulton County Stadium as well as at the Georgia Tech stadium, staffed by Cardiology Fellows, with patients transported to the hospital as needed.
A film was produced based on the first successful resuscitation (by a Turner Field ticket taker) just outside the stadium in the ticket line. Other Grady studies included the Coronary Drug Project, the Persantine Aspirin Trials (AMIS and PARIS), the Urokinase Pulmonary Embolism Trial, the Urokinase Streptokinase Pulmonary Embolism Trial, the National Exercise and Heart Disease Project, the Heart and Estrogen/Progestin Replacement Study, BHAT (the Beta blocker Heart Attack Trial), the Raloxifene Use for the Heart Study, the Treating to New Targets (TNT) Trial, GUSTO V (Evaluation of the Efficacy of Reopro in Combination with Reduced Dose Retavase), as well as early trials on oral direct thrombin inhibitors and antiplatelet thrombin inhibitor therapy, transitioning currently to a series of impressive heart failure trials. Grady was a major enroller for the Women’s Health Initiative, headed by the late Dr. Dallas Hall.
In 2009, Grady was just beginning to emerge from a frightening period of financial instability. It turned out to be true that adversity can lay the seeds of opportunity: With Grady’s emergence from near-collapse came an unprecedented outpouring of millions of dollars in philanthropic gifts to Grady. Most significant to the care of heart disease patients was a transformative gift to cardiology from Pete and Ada Lee Correll and their friends.
With the Correll gift, Grady, in conjunction with Emory and Morehouse cardiology physician leadership, was able to renovate and expand the cardiac catheterization laboratories, establish Grady’s first ever 24/7 STEMI program (now one of the busiest in the city) under the leadership of Dr. Michael McDaniel, establish Grady’s first ever cardiac electrophysiology program under the leadership of Dr. David Hirsh, and revive Grady’s cardiac surgery program under the leadership of Dr. Brent Keeling. This growth continues today as Grady is constructing both a third cardiac catheterization lab and a hybrid operating room. Additionally, the hospital and its physicians are enjoying a resurgence of cardiac research with Grady having been invited to participate in several ongoing national and international trials.
In addition to all the accomplishments of Grady’s cardiology program over the years, enormous gratitude must be expressed to the fabulous patients at the hospital who trusted the physicians and hospital with their care; who participated in the teaching and training of generations of medical students, interns, residents and postgraduate trainees; and who volunteered as participants in important clinical research studies that shaped cardiovascular medicine into what it is today. As billboards across the city proclaim: “Atlanta can’t live without Grady, and Grady can’t live without Atlanta”. This is nowhere truer than within cardiology at Grady.
