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November 25, 2009 -- 6:15pm EST Fractional Flow Reserve (FFR) Recognized in Guidelines,
Not So Much In Reimbursement So FAME and the value of Fractional Flow Reserve (FFR) have now found their way into the official PCI guidelines. Last week, the ACC/AHA/SCAI issued their first Focused Updates -- a way of responding more quickly to recent and important clinical and research information (guidelines normally are only issued every two to three years) -- and FFR was included as "useful to determine whether PCI of a specific coronary lesion is warranted." The two manufacturers of FFR catheters, Volcano and St. Jude, feel that functional measurement (FM) is going to be a rapidly growing field. With the upgrade in the Focused Guidelines this may be so. But, as usual, reimbursement is lagging behind. Interventional cardiologists may see the scientific evidence that FFR improves outcomes but, if there isn't sufficient reimbursement for its use, they will be less inclined to use it. Augusto Pichard, MD of Washington Hospital Center told me he doesn't have this problem because he did an analysis of how much money was saved by using this technology and his hospital "got it". And, as William F. Fearon, MD of Stanford University Medical Center observed, "Use of FFR technology represents a rare opportunity in medicine in which an innovative product not only improves clinical outcomes but also saves money." Lower costs and a third less heart attacks and deaths. FFR should be in every cath lab, right? Yet currently penetration of this technology in the U.S. is only 5%. Comments? |
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When
I heard Dr. Nico Pijls first present data from the FAME study during
a press conference at the 2008 TCT,
I was struck by the similarity of
the concept to what Andreas Gruentzig, inventor of coronary angioplasty,
was doing in the early days of balloons: measuring intra-arterial
pressures to discern what exactly was going on inside the coronaries
during these procedures. I brought this up
with Dr. Pijls and he agreed. I've detailed
this whole thread back in my January post titled,