Faculty Spotlight: Joseph Bayne, MD
Providing Lifelong Care to Patients with ACHD
Photo credit: Andrea Rowe, UCSF
Growing up, Joseph Bayne, MD, witnessed a family member navigate challenges related to congenital heart disease (CHD) – a birth defect of the heart. “It definitely felt like there was a shadow over the future,” he recalled.
When Dr. Bayne was a teenager, his relative needed to undergo open-heart surgery to replace a faulty heart valve. “Later on, he needed another valve replacement, but he didn’t have to have open-heart surgery this time because he was able to receive a transcatheter valve replacement, which was new at the time,” said Dr. Bayne. “His recovery was so much easier the second time around, and it was remarkable to see the progress in the field. That reinforced my desire to become a doctor in the field of adult congenital heart disease (ACHD).”
ACHD includes dozens of different conditions, each with its own anatomy and treatment strategy. These conditions develop before birth, and often vary greatly in presentation and severity. Until recently, most patients with complex forms of CHD died as children or young adults, but surgical advances have allowed many to reach adulthood and even old age. However, most of these patients are not “cured,” and sometimes require subsequent surgeries or other treatments. There are now an estimated 1 million Americans adults living with congenital heart disease, and most should ideally receive specialty care throughout their lives to keep them as healthy as possible.
Harmonizing Care for Patients with ACHD
Dr. Bayne grew up in Fremont, Calif., moving across the Bay to attend Stanford University, where he earned a bachelor’s degree in biology. He deferred a year of medical school to learn Spanish while serving as a student intern at an underserved community health clinic in Nicaragua, becoming a certified medical Spanish interpreter. This helped him provide effective and culturally competent care during medical training and residency, and he continues to provide care for Spanish-speaking patients in his clinical practice.
While earning his medical degree from Columbia University College of Physicians and Surgeons, Dr. Bayne conducted research supported by the Howard Hughes Medical Institute on sodium channel mutations in mice with atrial fibrillation, a common abnormal heart rhythm. He then completed his internal medicine residency from NewYork-Presbyterian Hospital, which is affiliated with Columbia University.
He chose UCSF for his general cardiology and ACHD fellowships because of its excellent research and clinical training opportunities. “I enjoyed learning cardiology at three different campuses, and learning how to best deliver care to different patient populations,” said Dr. Bayne. “Depending on what’s available at that hospital and a patient’s social situation, there may be different ways to connect patients with the treatments they need. For example, UCSF Health offers all the latest treatments and subspecialties, but patients might live eight hours away, so we need to consider how that affects how we provide care. On the other hand, at San Francisco General Hospital, all the patients live in San Francisco, but the great majority don’t have private insurance and are on Medi-Cal. If they need subspecialty care, we usually have to refer them elsewhere, usually UCSF Health, and figure out how to get [insurance] coverage for those procedures.”
That customized approach to care is amplified when caring for patients with ACHD. “There are many different variations of the same disease, and treatments are not one-size-fits-all,” said Dr. Bayne. “On top of that, patients coming from different parts of the country or even different parts of the same state may have undergone different types of surgery, based on what their surgeon was most known for or was able to do. Those treatments also have evolved over time. For example, a patient with transposition of the great arteries may have undergone a treatment called atrial switch in the 1970s or 1980s, but in a different part of the country, they may have undergone arterial switch.”
That treatment history has major implications for their future care. “Patients develop completely different problems based on which operation they had, even if they had the same initial anatomy,” said Dr. Bayne. “Knowing how to obtain a detailed patient history and determining their treatment plan based on their specific history is really important, and is something I learned during my ACHD fellowship.”
Dr. Bayne also learned the importance of communicating with multiple providers both within and outside of cardiology to effectively coordinate patient care. “For example, if you have a patient with a single ventricle and they get something called a Fontan procedure, they’re more likely to develop liver disease, kidney disease, pulmonary vascular disease, and arrhythmias,” said Dr. Bayne. “So you’re in close communication with the hepatologist, nephrologist, pulmonologist and electrophysiologist. Some ACHD patients are more likely to develop endocarditis, an infection of the lining of the heart, so you’re in communication with infectious disease colleagues.”
Like an orchestra conductor, an ACHD specialist coordinates input and expertise from all these subspecialists and more. “Even if you aren’t a soloist on any of these instruments, you need to know about a lot of different instruments to be able to harmonize a patient’s care,” said Dr. Bayne. “If anything happens, it’s important to get all the right people involved.”
One vital member of the orchestra is the patient themselves. “We try to make sure that a patient completes all their diagnostics before the appointment so we can make good use of our time together in clinic,” said Dr. Bayne. “If they live far away, our staff tries to schedule tests in one day to make it easier for everyone.”
He and his ACHD colleagues also help younger patients navigate the health care system. “It’s a very big transition when young adults age out of pediatric CHD care and come to us,” said Dr. Bayne. “Until that point, their parents or guardians managed everything for them, and then suddenly they’re thrown into a situation where they’re now responsible for taking care of themselves. Some patients need to schedule regular appointments not only with us, but also with their hepatologist, nephrologist and other specialists, as well as periodic echocardiograms and other tests. It can be very overwhelming for them, so it’s really important to communicate and figure out what works best for them.”
Sometimes that involves looping in a parent or social worker to help schedule appointments with a multitude of specialists as well as ongoing diagnostic tests. “Some patients are learning disabled and really do need that extra person to help them,” said Dr. Bayne. “It’s important to assess the patient’s level of understanding and what they can and can’t do for themselves. When someone with a complex history of CHD isn’t showing up to their appointments, they are more likely to need care in the emergency department and emergency surgery. That’s traumatizing, and often their health outcomes are worse.”
Dr. Bayne has a special interest in caring for patients with pulmonary hypertension, a condition characterized by high blood pressure in the lungs. “It’s a disease that’s related to pulmonology, but definitely has a cardiac component,” he said. “People with CHD are up to ten times more likely than the general population to develop pulmonary hypertension in adulthood. This is a population that tends to be very sick, but I’ve seen the turnaround of some patients who could barely walk to the kitchen and back feel much better with new medications.”
“Dr. Bayne is a passionate clinician and researcher interested in the genetics of pulmonary hypertension in patients with congenital heart disease,” said Marc Simon, MD, MS, director of the UCSF Pulmonary Hypertension Comprehensive Care Center. “We are fortunate to have him join the UCSF Cardiology faculty.”
Charting New Waters in ACHD
Dr. Bayne wants to discover more about the underlying causes of pulmonary hypertension associated with ACHD. “Many patients have a hole in their heart, which allows blood to move from the left side of the heart to the right side, which creates more blood flow to the pulmonary vasculature and results in pulmonary hypertension,” he said. “But not all patients fit that picture. We want to figure out why that is, and discover whether there is a genetic association with this phenomenon. We could also use imaging, such as MRI (magnetic resonance imaging) four-dimensional flow, to allow us to look at vortices and blood flow, which might allow us to detect pulmonary hypertension earlier in patients who may be more prone to it. Are there ways we can diagnose this sooner without having to use an invasive catheter procedure?”
“Dr Bayne is conducting impressive research on the important and understudied topic of congenital heart disease and pulmonary hypertension,” said Anu Agarwal, MD, a UCSF ACHD specialist. “He has taken the initiative to network with multiple researchers across several institutions, demonstrating his interpersonal skills and leadership as he creates a large database of congenital patients with pulmonary hypertension. He is very sharp and dedicated, and has a passion for eliminating health disparities and improving care for all patients.”
Dr. Bayne has many other unanswered questions, such as whether patients with CHD are more likely to get coronary disease at a younger age, and whether statins could help prevent coronary disease or valvular disease.
In addition to research, he enjoys helping trainees better understand the complex world of ACHD. “While it can be really interesting to learn about the developmental biology of CHD, I encourage them to focus on pulling out the right information about a condition and how it applies to taking care of patients,” said Dr. Bayne. “Most children with CHD won’t survive into adulthood without intervention, so they’ve already been diagnosed. You’re building off that, and as an ACHD cardiologist, you’re figuring out what they were born with, what treatment they’ve received in the past, what to look for in imaging, and what will help them have less symptoms and live long, healthy lives.”
As treatments improve and survival rates increase for patients with CHD, the population of people with ACHD continues to grow. Dr. Bayne envisions that in the future, subspecialty ACHD fellowship programs will encourage trainees to develop particular expertise in echocardiography. That will enhance their ability to interpret the nuances of imaging the complex anatomy of patients with ACHD to guide treatment. “For example, because of a patient’s congenital lesion, if we are implanting a heart valve into someone with ACHD, it’s not one size fits all,” said Dr. Bayne. “We may need to use a different size valve, or use a different method of placing it.”
Dr. Bayne spends most of his clinical time caring for patients in the UCSF ACHD Clinic, with additional duties in the UCSF Pregnancy and Cardiac Treatment (PACT) Program, as well as caring for hospitalized patients with ACHD. He often shares his own experience of having a family member with ACHD with patients. “I relate to the patient’s family, and understand their worry,” he said. “It’s really fulfilling to give recommendations, treatment, advice and guidance, and often to have such improvement and good outcomes.”
The field of ACHD continues to grow, and as many patients now live into middle age and even elderhood, ACHD cardiologists like Dr. Bayne are continuing to discover how to best treat these patients as they grow older. “Nowadays it’s very common to have patients in their 50s and 60s, and I’ve even had a patient in their 80s,” he said. “We don’t yet know the full extent of how their condition unfolds, and the story is still being written for many of our patients because they are now able to reach later and later stages of adulthood.”
Outside of medicine, Dr. Bayne enjoys playing the piano, running, and traveling.
- Elizabeth Chur