(Press-News.org) WASHINGTON, DC, and DALLAS (March 17, 2014) – The increasing number of percutaneous coronary interventions (PCIs) being performed at low-volume centers without on-site cardiac surgery backup has driven the need for new safety and quality protocols, according to an expert consensus document released today and written by a committee representing the Society for Cardiovascular Angiography and Interventions (SCAI), the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA). The document outlines steps hospitals can take to provide the safest possible environment for PCI when the facility does not provide cardiac surgery as a backup should complications occur.
"This issue was last reviewed in 2007, and since that time interventional cardiology has seen important changes," said Gregory J. Dehmer, MD, FACC, FSCAI, director of the Division of Cardiology at Baylor Scott & White Health, Central Texas (Temple, Texas) and the document's lead author. "The new recommendations aim to increase safety while maintaining access to quality care for underserved patients."
PCI is a common procedure performed to open blocked arteries. Frequently, a tiny metal mesh tube called a stent is used to help keep the artery open. There are two primary situations when a patient undergoes PCI: (1) during a heart attack, when emergency PCI is performed to open the completely blocked artery and limit damage to the heart muscle, and (2) during an elective procedure, a non-emergency situation typically to relieve stable angina symptoms when medications alone are not completely effective.
Although PCI use increased significantly since the procedure was introduced more than 30 years ago, for a variety of reasons use peaked in 2006 and has since dropped by nearly a third. Advances in drug-eluting stents, greater use of medication to treat some types of blockages, increased emphasis on heart disease prevention, and new technologies to help physicians better evaluate blockages have all contributed to a drop in PCI use.
This drop has led to an increase in the number of facilities that are considered "low volume," or performing fewer than 200 PCIs per year, according to the consensus document. Overall, one-third of facilities performing PCI had no on-site cardiac surgery, and among those hospitals, about two-thirds were considered low volume.
The consensus document cites studies and meta-analyses since 2006 that find no indication of increased mortality or a greater need for emergency bypass surgery for either heart attack or elective PCI patients at sites without on-site cardiac surgery. In general, it said, safety questions about sites without surgical backup have diminished "in the presence of a proven, well-defined and protocol-driven approach."
However, the paper echoed an earlier joint recommendation that low-volume PCI programs "must have stringent systems and process protocols in place" with close monitoring of outcomes and strategies that encourage collaboration with higher-volume facilities.
"As the technique and equipment for PCI has improved, the evidence from randomized studies suggests that procedures can be performed safely without on-site surgery," said Dr. Dehmer. "But at the same time, the number of low-volume centers is increasing, making it essential that those facilities without backup cardiac surgery have strict protocols in place to ensure the highest level of patient safety."
The consensus document compiles the recommendations made by various organizations in several different documents into one resource for use by facilities without on-site surgery. These include a greater emphasis on quality review programs, the recommended number of procedures physicians should perform per year to maintain their skills, mentoring for newly trained cardiologists and criteria to evaluate PCI programs. It also recommends a shift in focus to system-wide planning for rational distribution of PCI services.
"The expansion of small PCI programs without on-site surgery has not substantially improved access to PCI," said Dr. Dehmer. "Although the number of facilities capable of performing PCI has increased 44 percent, the number of people who live within a one-hour drive of a PCI facility has increased only slightly. Today about 80 percent of the population is within one-hour of a PCI hospital." Recent surveys found expansion of PCI reduced drive times for just 9 percent of the population.
The document also supports the ongoing study and surveillance of all PCI programs through participation in national databases, encourages public reporting of results and acknowledges further declines in PCI volumes might necessitate the closure of some PCI programs in the future.
The new consensus document, titled, "SCAI/ACCF/AHA Expert Consensus Document Update on Percutaneous Coronary Intervention without On-Site Surgical Backup," updates a 2007 consensus document. It will be published online today in Catheterization & Cardiovascular Interventions, Journal of the American College of Cardiology (JACC) and Circulation: Journal of the American Heart Association.
INFORMATION:
About the Society for Cardiovascular Angiography and Interventions
The Society for Cardiovascular Angiography and Interventions is a 4,000-member professional organization representing invasive and interventional cardiologists in approximately 70 nations. SCAI's mission is to promote excellence in invasive/interventional cardiovascular medicine through physician education and representation, and advancement of quality standards to enhance patient care. SCAI's public education program, Seconds Count, offers comprehensive information about cardiovascular disease. For more information, visit http://www.SCAI.org/ or http://www.SecondsCount.org. Follow @SCAI and @SCAINews on Twitter for the latest heart health news.
About the American College of Cardiology
The mission of the American College of Cardiology is to transform cardiovascular care and improve heart health. The College is a 47,000-member medical society comprised of physicians, surgeons, nurses, physician assistants, pharmacists and practice managers. The College is a leader in the formulation of health policy, standards and guidelines. The ACC provides professional education, operates national registries to measure and improve quality of care, disseminates cardiovascular research, and bestows credentials upon cardiovascular specialists who meet stringent qualifications. For more information, visit http://www.cardiosource.org.
About the American Heart Association
The American Heart Association is devoted to saving people from heart disease and stroke – America's No. 1 and No. 4 killers. We team with millions of volunteers to fund innovative research, fight for stronger public health policies, and provide lifesaving tools and information to prevent and treat these diseases. The Dallas-based association is the nation's oldest and largest voluntary organization dedicated to fighting heart disease and stroke. To learn more or to get involved, call 1-800-AHA-USA1, visit heart.org or call any of our offices around the country. Follow us on Facebook and Twitter.
Document addresses improving quality, safety for PCIs performed without on-site backup
2014-03-17
ELSE PRESS RELEASES FROM THIS DATE:
Antarctic moss lives after 1,500+ years under ice
2014-03-17
Researchers from the British Antarctic Survey and University of Reading report in the Cell Press journal Current Biology on March 17 that Antarctic mosses can essentially come back to life after 1,500 completely inactive years under the ice.
Prior to this finding, direct regeneration from frozen plant material had been demonstrated after 20 years at most. Beyond that, only microbes had been shown to be capable of revival after so many years on hold.
"These mosses were basically in a very long-term deep freeze," says Peter Convey of the British Antarctic Survey. "This ...
Overpopulation: The transparent elephant in the room causing crucial modern crises
2014-03-17
A review of nearly 200 research articles (~75% published in the last ten years) shows how the issue of population growth is being downplayed and trivialized despite its fundamental role on modern crises related to unemployment, public debt, welfare (e.g., reduced access to food and water or even health and education), extinction of species and climate change. The study suggests that no foreseeable pathways, to fix or ameliorate such crises, are likely without seriously dealing with natality rates by both developed and developing nations.
The paper is written by Camilo ...
Younger men receive faster care for heart attacks, angina compared with women of same age
2014-03-17
A new study indicates that in younger adults experiencing heart attacks and angina, men are more likely to receive faster care compared with women. The study, published in CMAJ (Canadian Medical Association Journal) also found that gender-related factors affected access to care for both men and women.
To understand why sex differences in mortality exist in younger men and women with acute coronary syndrome, researchers included 1123 patients aged 18 to 55 years recruited from 24 centres across Canada, 1 in the United States and 1 in Switzerland. Of the participants, ...
Back to life after 1,500 years
2014-03-17
Researchers from the British Antarctic Survey and Reading University have demonstrated that, after over 1,500 years frozen in Antarctic ice, moss can come back to life and continue to grow. For the first time, this vital part of the ecosystem in both polar regions has been shown to have the ability to survive century to millennial scale ice ages. This provides exciting new insight into the survival of life on Earth.
The team, reporting in Current Biology this week, observed moss regeneration after at least 1,530 years frozen in permafrost. This is the first study to show ...
Fighting antibiotic resistance with 'molecular drill bits'
2014-03-17
DALLAS, March 17, 2014 — In response to drug-resistant "superbugs" that send millions of people to hospitals around the world, scientists are building tiny, "molecular drill bits" that kill bacteria by bursting through their protective cell walls. They presented some of the latest developments on these drill bits, better known to scientists as antimicrobial peptides (AMPs), at the 247th National Meeting & Exposition of the American Chemical Society (ACS), the world's largest scientific society.
The meeting, which features more than 10,000 scientific reports across disciplines ...
Shale could be long-term home for problematic nuclear waste
2014-03-17
DALLAS, March 17, 2014 — Shale, the source of the United States' current natural gas boom, could help solve another energy problem: what to do with radioactive waste from nuclear power plants. The unique properties of the sedimentary rock and related clay-rich rocks make it ideal for storing the potentially dangerous spent fuel for millennia, according to a geologist studying possible storage sites who made a presentation here today.
The talk was one of more than 10,000 presentations at the 247th National Meeting & Exposition of the American Chemical Society (ACS), the ...
How the science of deer hunting can help patients with diabetes
2014-03-17
DALLAS, March 17, 2014 — Body odor is a deer hunter's worst enemy, an alert to animals that an ominous presence is lurking, but the science behind suppressing it to give hunters an edge oddly enough could help researchers develop a life-saving device for diabetes patients. Scientists today presented the latest advances that tie together these two seemingly unrelated fronts at the 247th National Meeting & Exposition of the American Chemical Society (ACS), the world's largest scientific society.
The meeting, attended by thousands of scientists, features more than 10,000 ...
Study finds that fast-moving cells in the human immune system walk in a stepwise manner
2014-03-17
VIDEO:
A team of biologists and engineers at UC San Diego applied advanced mathematical tools to answer a basic question in cell biology about how cells move and discovered that the...
Click here for more information.
A team of biologists and engineers at the University of California, San Diego has discovered that white blood cells, which repair damaged tissue as part of the body's immune response, move to inflamed sites by walking in a stepwise manner. The cells periodically ...
New reason to eat oats for heart health
2014-03-17
Dallas, TX, March 17, 2014: Eleven top scientists from around the globe presented the latest findings on the powerful compounds found in oats in a scientific session titled, Physicochemical Properties and Biological Functionality of Oats, at the 247th Annual Conference of the American Chemical Society in Dallas, TX. Scientists described research on the diverse health benefits of oats and emphasized the growing evidence that the type of phenolic compound avenanthramide (AVE) – found only in oats – may possess antioxidant, anti-inflammatory, anti-itch and anti-cancer properties. ...
Primary androgen deprivation therapy ineffective for most men with early prostate cancer
2014-03-17
WASHINGTON — A study of more than 15,000 men with early stage prostate cancer finds that those who received androgen deprivation as their primary treatment instead of surgery or radiation did not live any longer than those who received no treatment.
The research team, led by scientists at Georgetown Lombardi Comprehensive Cancer Center, say that the risks of serious adverse events associated with the treatment — which has been linked to impaired cognition, heart disease, diabetes and other disorders — "mitigates against any clinical or policy rationale for use of primary ...