Tommy Lasorda, photo by Phil Konstantin
Before he was Hall of Fame manager of the Los Angeles Dodgers, Tommy Lasorda was a scout and coach for the team. And part of his duties was to teach the rookies. So, in that tradition, there is a lesson in Tommy’s latest health scare: if you think you may be having a heart attack, get to the hospital ASAP, preferably a hospital that performs emergency angioplasty. Continue reading
Filed under Celebrity Patients, Heart Attack, Video
I’m looking at this morning’s news and I’m seeing headlines like these: “Stents Overused in Stable Heart Patients” (WebMD), “Pills as good as stents for stable heart patients” (Reuters), “No Extra Benefits Are Seen in Stents for Coronary Artery Disease” (New York Times), and “Stents no better than pills for some heart patients” (MassDevice) — and I think I have time-traveled half a decade back to March 2007 when the results of the COURAGE study were presented at the American College of Cardiology Annual Meeting. Continue reading
Filed under Clinical Trials / Studies, COURAGE, Media Coverage, Stent
Forgive the perverse Shakespearean pun in the title but, as the Bard wrote: “What’s in a name? That which we call a rose by any other name would smell as sweet.” My topic is pretty much the polar opposite of roses, but the whole concept of labels and what we call things has become increasingly important. It’s one that I touched on in my post over last weekend about the impending CMS audits of stent procedures: namely, that the “official” terms used to describe treatment of a blocked artery are flawed when it comes to proper use of the English language.
The official “Appropriate Use Guidelines” place stent and angioplasty procedures into three categories: Appropriate, Uncertain and Inappropriate. Any patient, potential patient or, for that matter, anyone not steeped in the minutiae of interventional cardiology, would look at those terms and assume that any doctor putting a metal coil into someone’s heart when the procedure was labeled “uncertain” or “inappropriate” should be fined or fired or both. Continue reading
Filed under Appropriate Use Criteria (AUC), COURAGE, Media Coverage, Stent
The question of the day, regarding whether or not to stent a coronary artery, is now being brought to the forefront by the U.S. government in the form of a Medicare “Demonstration Project”. And by “brought to the forefront”, I mean MONEY! — as in “we won’t pay you if we determine that the stent procedure was inappropriate.”
The bottom line is that, on November 15, CMS announced “New Demonstrations to Help Curb Improper Medicare, Medicaid Payments“. These so-called “demonstrations” will occur in 11 states where claims “historically result in high rates of improper payments”: Florida, California, Michigan, Texas, New York, Louisiana, Illinois, Pennsylvania, Ohio, North Carolina and Missouri. Continue reading
Dr. Habib Samady of Emory in Atlanta at IVUS console
I’ve written before about the use of IVUS in stent and angioplasty procedures in women, most recently in October about a study done at NYU Medical Center. My article, “Intravascular Ultrasound (IVUS) Imaging Reveals Hidden Heart Attack Culprit In Women“, showed how intravascular imaging could detect a type of coronary disease not seen on angiography.
Now a similar tale has been broadcast by CBS affiliate WGCL-TV in Atlanta about how a type of coronary narrowing more typical in women may not be seen on a standard angiogram because it’s evenly distributed along the arterial wall or channel and doesn’t appear as a “spike” or sudden narrowing — yet it may be restricting the flow of blood to the heart just the same. Once again — angiography alone is not enough to accurately diagnose coronary artery disease and guide its treatment. Continue reading
Filed under IVUS, Media Coverage
Dr. Ralph Brindis is the Immediate Past President of the American College of Cardiology and helmed the National Cardiovascular Data Registry (NCDR) since its inception in 1997 — this is the registry that was the source for the data analyzed and reported in yesterday’s JAMA study, “Appropriateness of Percutaneous Coronary Intervention.”
In my exclusive interview with Dr. Brindis, I talked with him about the study, his feeling about what it showed, both the positive findings and what he calls “opportunities for improvement.” While there was almost 100% adherence to guidelines for acute angioplasties (which made up 71% of the total angioplasties performed) the study also pinpointed the fact that PCIs for non-acute patients had a higher rate of “inappropriates”, as defined by the ACC/SCAI Appropriateness Criteria — and that this rate varied widely from hospital to hospital. This means that those hospitals with higher than average “inappropriate” PCIs needed to look at their cases, their decision-making process and work to bring it closer to the norm. Continue reading
A major study of a half-million angioplasties, published today1 in the Journal of the American Medical Association (JAMA), refutes two major myths about angioplasty and stent use in the United States: myth #1, that angioplasty is vastly overused and unnecessary in most cases; and myth #2, that most angioplasty is used in stable patients and therefore has little or no benefit over drugs in reducing death or heart attacks.
Titled “Appropriateness of Percutaneous Coronary Intervention“, this paper is the first comprehensive look at how closely interventional cardiologists in the U.S. are adhering to the practice guidelines for PCI (angioplasty and stenting) most recently published by the professional cardiology and surgical societies in January 2009. Continue reading
Filed under Appropriate Use Criteria (AUC), COURAGE, Media Coverage
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