Keila N. Lopez: Thinking Outside the Box to Move Pediatric Cardiology Care Forward

Embracing a new philosophy in pediatric heart care

“That’s just the way it is.”

Keila N. Lopez, MD, MPH, doesn’t like that phrase. After years of navigating many facets of pediatric cardiology, she embraced thinking outside of the traditional box that has defined her field.

When Dr. Lopez first started her career, her passions intersected at cardiology and public health. She was told back then that if she wanted to pursue both interests, she would need to work on research related to preventative cardiology, such as obesity-related conditions. Researchers had already done a lot of work in this area and she thought her efforts could be put to better use elsewhere. Thankfully, she persisted and found an area that involved public health, health equity research and quality improvement — transitional care for adolescents with congenital heart disease (CHD).

Addressing the gap in congenital heart disease care for teenagers

As care has improved over the years, more and more children with CHD are reaching adulthood and need the skills and knowledge required to become successful adults living with a chronic disease. Before coming to Children’s Hospital Colorado’s Heart Institute, Dr. Lopez set up the Cardiology Transition Medicine Program at Texas Children’s Hospital for that exact reason.

Congenital heart care often starts at or even before birth and a significant amount of programmatics and research focuses on the fetal and neonatal periods. Emerging programs and research also focused on adults with congenital heart disease. Dr. Lopez recognized a gap as patients transitioned from pediatric to adult care, so she placed her initial focus on teenagers.

“I don't know why teenagers’ voices were being left out of this equation because they are the ones that are surviving,” says Dr. Lopez. “They are the ones that are going to be adults, and they are the ones that have to understand how to navigate a complex medical system and understand insurance. While, as a field, we provide lifelong care (from fetal to adult), I started with teenagers because of my own clinical frustration. I'd be in clinic and I'd ask my patient, ‘Can you tell me about your heart condition?’ And they would look at their mom and then she would answer. They were about to turn 18 and were completely unprepared.”

Changing the conversation around subspecialty heart care

As Dr. Lopez dove deeper into the culture of her field, she noted that, for physicians, clinical work rarely converged with public health, health policy and advocacy.

“We as cardiologists seemed reticent to fully embrace holistic care, including areas like mental health and future life planning,” she says. “These are the things that we left at the door once we graduated from pediatric residency. Now as a cardiologist, I've learned that our patients deserve comprehensive discussions about these things because so many people are terrified to talk about them. Previously, we weren't talking about important aspects of a future life with CHD — ‘Hey, have you thought about a future job? Are you going to college? How are you going to get insurance? Do you know what insurance means?’”

Dr. Lopez saw how unprepared her adolescent patients were and when she spoke to other cardiologists about it, she would hear, ‘This is not our lane’ or ‘That’s just the way it is.’ She decided it could be better. As time passed, the appetite for Dr. Lopez’s approach grew. Now she inspires younger colleagues and fellows to be curious and to ask the questions that others in the field may not be asking — something she yearned for when she started.

“When I entered pediatric cardiology, public health and advocacy were just starting to become more of a dialogue,” Dr. Lopez says. “Before that, these things were very much relegated to general pediatrics. People said, ‘Public health? Advocacy? That’s a Gen. Peds thing.’ Health policy was even less of a part of the dialogue. I said, ‘Why are we not doing this? I don't understand why we're not putting more of a focus on health policy and health equity in education and research in subspecialty care because we take care of the sickest patients.’”

Bringing a fresh and welcome perspective to Children’s Colorado

Dr. Lopez wears many hats and her work cycles between clinical duties, advocacy, research and faculty duties. She says one thing that helped her make the decision to come to Children’s Colorado was a discussion she had with Shelley Miyamoto, MD, FAHA, Chair of Pediatric Cardiology and Co-Director of the Heart Institute.

“Shelley and I had this bigger conversation about what is possible within pediatric cardiology and how we could create this unique role that focused on mentorship, sponsorship, faculty development, health policy and research. We talked about how we again diversify the focus within pediatric cardiology to include policy and implementation science for some of the highest-risk conditions in pediatrics.”

Now Dr. Lopez is turning her focus on integrating health policy and implementation science into subspecialty pediatric care. She hopes these efforts will improve access to care, advance health equity and advocacy and ensure sustainability and collaboration across care teams throughout patients’ lives. She plans to further her policy work through collaboration with the Eugene S. Farley, Jr. Health Policy Center and the new Child Heath Policy Center at Children’s Colorado.

Inspiring unique perspectives in pediatric cardiology

Dr. Lopez says we need to break down silos between research, quality improvement, clinical care and health policy so we can learn what benefits kids with CHD and disseminate it widely. Her strategic priorities include:

• Finding unique ways for faculty to diversify their career portfolios
• Advocating for health policies to improve lifelong access to care
• Reducing health inequities by recognizing and addressing unequal social drivers of health
• Advancing holistic and reimbursable care models
• Implementing evidence into clinical practice

Finally, Dr. Lopez has spent a large portion of her career dedicated to mentorship and sponsorship, particularly for women in pediatric cardiology. It’s part of what drove her to take a leadership role in faculty development at the Heart Institute. She has a real passion for helping young faculty determine their true aspirations and realizing that out-of-the-box careers are possible. She has also harnessed the power of peer mentorship and leads a national book club on women in leadership for mid-career academic women in pediatric cardiology.

The research and work Dr. Lopez is doing to improve health policy will surely pave the way to better care. But perhaps even more important is the work she is doing to mentor the next generation of women to take leadership roles in pediatric cardiology.

So, when these women are told at some point in the future, ‘That’s just the way it is,’ they’ll be able to confidently respond, ‘No, we can do better.’