Why Early Referral Changes Outcomes in Structural Heart Disease at Atlantic Health Morristown Medical Center

November 4, 2026
Gennaro Giustino, MD

 

 

Structural heart disease often begins with detection, but the next critical step is determining whether underlying anatomy introduces complexity that may influence intervention strategy, timing, or candidacy. 

At Atlantic Health Morristown Medical Center, early collaboration between referring physicians and structural heart specialists is encouraged whenever anatomical questions arise or when disease progression may outpace traditional management pathways. 

Gennaro Giustino, MD, structural interventional cardiologist at Atlantic Health, emphasizes the distinction between identifying disease and fully understanding its structural implications. While primary care physicians and general cardiologists play a central role in detecting valve disease and correlating symptoms, deeper anatomical evaluation often reveals factors that can influence treatment planning. 

“There is a distinction between disease detection and understanding the complexity of the disease,” Dr. Giustino explains. Once patients are referred, structural heart specialists can perform a more detailed assessment to determine whether a condition is straightforward to manage or may require advanced techniques or multidisciplinary planning. 

The Importance of Early Involvement 

Early referral allows time for thoughtful imaging review, heart team discussion, and shared planning before symptoms escalate or urgency develops. Structural heart decisions often hinge on anatomy, and earlier evaluation can clarify candidacy for transcatheter therapies, surgical intervention, or continued monitoring. 

Dr. Giustino encourages physicians to consider consultation sooner rather than later, particularly when disease severity, symptom progression, or prior interventions raise uncertainty. Early involvement helps identify patients who may benefit from advanced therapies while they are still stable enough to undergo elective evaluation. 

Collaboration and Continuity 

A common concern among referring physicians is maintaining continuity of care. At Atlantic Health Morristown, the structural heart program is built around collaboration, not transfer of ownership. 

Dr. Giustino notes that the team works closely with referring physicians, reviewing imaging, discussing candidacy, and maintaining open communication throughout the evaluation and treatment process. Importantly, patients continue to rely on their primary cardiologist for longitudinal management and shared decision-making. 

“A core component of providing excellent care to these patients is that they don’t lose their primary cardiologist,” he emphasizes. “The primary cardiologist remains at the center of the decision making.” 

A Multidisciplinary Heart Team Approach 

Structural heart intervention involves coordination among interventional cardiology, cardiac surgery, advanced imaging specialists, anesthesia teams, and heart failure clinicians. At Atlantic Health Morristown, multidisciplinary discussion is routine, allowing complex cases to be evaluated from multiple clinical perspectives before a treatment pathway is defined. 

This team-based model supports more deliberate decision-making and ensures that both referring physicians and patients understand the full range of available options. 

When to Consider Referral 

Early structural consultation may be appropriate for patients with: 

• Progressive valvular disease 

• Prior valve surgery or repair 

• Anatomical uncertainty on imaging 

• Severe disease with evolving symptoms 

Even when intervention is not immediately required, early evaluation can clarify monitoring strategies, anticipate future needs, and reduce the likelihood of urgent decision-making later in the disease course.