The Heart Attack & Stroke Prevention Center, of Spokane, is recovering from some growing pains.

The center, which is the flagship clinic of Bale/Doneen Method of heart attack prevention, recently expanded, adding a part-time provider and nearly doubling its space at 507 S. Washington, says Amy Doneen, medical director and clinic co-founder.

Meantime, academic and professional interest in the Bale/Doneen Method is continuing to grow, Doneen says.

Doneen, who holds a doctorate in nursing practice from Gonzaga University, is the principal provider at the clinic, which recently was joined by Dr. Pierre Leimgruber, a longtime Spokane physician, formerly with Providence Spokane Cardiology.

Leimgruber practiced 32 years as an interventional cardiologist, performing thousands of angioplasties and stent placements for patients with severe cardiovascular disease.

“He was looking at retirement from invasive cardiology, and he’s always been supportive of the preventive message,” Doneen says. “He’s coming over on a part-time basis and switching hats from doing traditional cardiology to 100 percent prevention.”

Doneen and Dr. Bradley F. Bale, a family physician formerly of Spokane, developed the Bale/Doneen Method, which focuses on optimizing blood-vessel health as a key to preventing heart disease and strokes. 

Bale moved in 2006 to Lubbock, Texas, where he currently is the medical director for the Grace Clinic Hearth Health Program. He also has a private clinical practice in Nashville, Tenn. 

The Heart Attack & Stroke Prevention Center here is a fee-for-service practice. Individual patients pay $2,600 annually and families pay $2,400 annually per participating member. The fee entitles patients to a minimum of quarterly visits and also covers any other appointments or unscheduled care throughout the year.

“People pay an annual fee and get unlimited care from me to make sure that those arteries stay healthy,” Doneen says.

The Bale/Doneen Method isn’t just about preventing a heart attack, Doneen says.

“It’s also about keeping the (blood vessel) system healthy and preventing memory loss, peripheral vascular disease, and end-stage kidney disease,” she asserts.

Doneen says she and Bale travel around the U.S. to lecture and teach the Bale/Doneen Method. They emphasize individualized, precision medicine to identify, treat, and prevent plaque buildup and inflammation in arteries.

“What causes a heart attack is not necessarily a slow narrowing of the arteries,” she says. “You get some sort of inflammatory cascade and the plaque ruptures through the artery wall and the body sends in all of these clotting factors to heal it. If that clot lands in the heart, we call it a heart attack. If it lands in the brain, we call it a stroke.”

Their model of treatment delves into root causes of vascular inflammation, such as gum disease, hormonal disorders, prediabetes, obstructive sleep apnea, psychosocial issues, and genetic lipid abnormalities, she says.

“Treating lipids is easy,” she says. “It’s all the rest that’s the challenge.”

Lipids are fats in the blood, including cholesterol.

The Bale/Doneen model calls for lab tests to detect plaque and inflammation in artery walls.

“They’re not expensive and they’re not extreme, but they’re not part of the normal workup,” Doneen says. “I want people to know that they are very available.”

The Heart Attack & Stroke Prevention Center here has about 400 patients. With the addition of Leimgruber, the clinic is taking new patients.

Doneen says she was unable to meet local patient demand on her own.

“It was to the point where I couldn’t take on any new patients until 2018,” she says. “Part of it is that I don’t do volume, because I do spend three-quarters of my time practicing prevention and about a quarter of my time lecturing and teaching, so it’s just trying to find that balance.”

Doneen says Leimgruber is seeing new patients and some continuing patients under the Bale/Doneen model.

“I’m opening the doors up now that Dr. Leimgruber is on board,” she says. “We added some square footage and expanded the office to handle it.”

The clinic also hired an additional employee to help with nursing and front-desk duties, she says.

The Heart Attack & Stroke Prevention Center now has five support employees, and Doneen says she outsources some clerical tasks.

Doneen says her practice isn’t competing with conventional medical practitioners.

“I require my patients have a primary-care provider,” she says. “If they’ve had any procedures with the heart, I require they keep their cardiologist.”

Doneen says she often receives referrals from cardiology groups that have patients who continue to have events even though they are treated by conventional standards.

Some patients come to the Heart Attack & Stroke Prevention Center because they’ve got a strong family history of strokes, dementia, or heart disease, and they want to see if they’re OK, she says.

While some patients are smokers or obese when they come to the practice, Doneen says, “The biggest common denominator of my patients is they are motivated to avoid heart attacks or strokes in their lifetime.”

Spokane-based Washington State University Elson S. Floyd College of Medicine last month extended a clinical faculty appointment to Doneen.

“That’s really exciting for me,” Doneen says. “We’re going to have students come through and observe … and get some of this in their curriculum from a family-practice standpoint.”

She says her goal is to make prevention through the vascular health model the new standard of care.

“Heart attack and stroke is still the leading cause of death and disability in this country, and I believe we have the knowledge and the science to change that,” she says. “Getting the academic appointment through WSU is one of the main steps to make that happen.”

The University of Kentucky College of Dentistry also recently has extended a faculty appointment to Doneen.

“So we can start looking at this model of medicine and dentistry formally working together,” she says. 

Doneen and Bale authored an article published a few months ago in Postgraduate Medicine demonstrating that gum-disease pathogens contribute to arterial disease.

Doneen asserts two academic papers—one published at Johns Hopkins University involving 324 patients and the other published at Texas Tech University involving 576 patients—show that the Bale/Doneen Method identifies, halts, stabilizes, and regresses plaque.

“That’s a big deal,” she claims. “We can stop heart disease.”

Doneen and Bale teach their prevention model to health care providers through formal continuing medical education courses backed by the American Academy of Family Physicians.

She says she and Bale have trained 500 physicians, most of whom bring various aspects of the Bale/Doneen Method into their established practices.

Eight practices so far are using the method exclusively, she says.

“People are opening Bale/Doneen practices around the country,” she says. “The latest one we’re going to lecture at is in Ohio, where a dentist and a cardiologist are starting up a group practice.”

The conventional standard of care for heart disease prevention mainly emphasizes control of cholesterol and blood pressure.

“It supports the blind optimism that (a heart attack) is not going to happen if your cholesterol is in check and your blood pressure is in check,” Doneen says. “That’s just not true; 64 percent of women who die of a heart attack have no idea that they were even walking around with vascular disease, and 50 percent of men who die of a heart attack have no idea that had vascular disease.”