July 2011

In an ideal healthcare setting, all clinical decisions would be supported by well-designed, randomized trials, which provide an unequivocal pathway for every patient. However, how should physicians act when these data are not available?

Cardiology practices now have opportunities to input their EHR data into clinical registries as U.S. healthcare moves toward a more accountable, quality-based model. The American College of Cardiologys (ACC) PINNACLE Registry could serve as a possible foundation for providers to gain a better understanding of their operations and ultimately help their bottom line.

The randomized, controlled RIVAL trial, presented in April at ACC.11, was expected to show a bleeding reduction with using radial access for PCI in patients with acute coronary syndromes (ACS). While the trial did not achieve its anticipated primary endpoint, transradial PCI may continue to gain utilization momentum if physicians succeed in deciphering how the results could impact their practice.

Much debate has surrounded which techniquemanual compression or vascular closureis best for hemostasis post-PCI. Now, newer generations of vascular closure devices (VCDs) have been proven to decrease length of stay, improve patient satisfaction and provide earlier time to ambulation. However, gaps in use still exist, due to questions about economic benefits and patient risks.

U.S. healthcare is undergoing massive changes. While its often easy to focus on the negative side-effects of this transformation, healthcare professionals should not lose sight of its many opportunities. One of the biggest opportunities, particularly for cardiology, is a movement towards team-based care, which involves using non-physician practitioners and clinical staff to participate in the decision-making, coordination of care and shared responsibility for quality.