November 2011

Man holding glasses

Six leading interventional cardiologists discuss landmark trials that have changed how they and their peers care for patients. In general, the selected standout studies focused less on stents and more on how physicians decide which patients and lesions are appropriate for stenting. Antiplatelets get a nod and, on the horizon, they identify percutaneous valve therapies as potentially transformative.

The stock markets are not the only entities that abhor uncertainty. The rational world of medicine also wrestles with unknowns, but unlike some investors, it doesnt let fear drive its responses.

Annually, an estimated 295,000 people in the U.S. experience out-of-hospital cardiac arrest, and only 6 to 10 percent survive (Circ 2011;123:e18-e209). Another 200,000 hospitalized patients suffer cardiac arrest each year, with only 25 percent surviving to discharge (Crit Care Med 2011, online). These overall survival statistics have seemed mired in the low digits for decades. But strengthening the American Heart Association (AHA) Emergency Cardiovascular Cares chain of survival may lead to improvements in outcomes for both out-of-hospital and inpatient cardiac arrest victims.

The Detroit Medical Centers new Cardiovascular Institute has produced faster angioplasty times with lower mortality and morbidity rates and shorter hospital stays, thanks to 24/7 availability of specialists and acute care technology.

In late 2009, Aspirus Heart & Vascular Institute in Wausau, Wis., was inspired to develop a dedicated heart valve center, in conjunction with a Valve Clinic, by both clinical and economic motivations. Since that time, the provider has seen an increase in referrals for surgical valve candidates, while also building in-house expertise of the complex disease states.

Evidence published earlier this year found that angiotensin-receptor blockers (ARBs), a drug class commonly prescribed to treat hypertension and sometimes cardiovascular events, may have the potential to increase the rates of new cancers by 8 to 11 percent. Here, the experts face off, arguing about whether ARBs are an effective drug class or whether this excess risk of cancer should cause concern.

Stroke ranks as the third leading cause of death and the leading cause of serious long-term disabilities in the U.S., according to the American Heart Association (AHA). Direct and indirect costs of stroke were $40.9 billion in 2007, with ischemic stroke having an individual lifetime cost of about $140,000. With the development of acute stroke centers, outcomes are improving for patients. By monitoring for stroke risk factors, such as atrial fibrillation, neurologists now can intervene before a second stroke occurs.

Interventional cardiology may face an upward of 32 percent slash to reimbursement beginning Jan. 1, 2012, due to the Medicare Sustainable Growth Rate (SGR) formula. In fact, payments for stent placements are set to decline nearly 4 percent. In the current realm of reimbursement ambiguity and healthcare reform, how will administrators keep their cath lab revenues from fading?

Transformational technologies bring with them challenges and opportunities. Upon development and introduction of these technologies, new strategies become available for treating a wider range of patients. Some of the biggest challenges are: what to compare it with; how to reimburse for it; how to train to utilize it; and how to integrate it into the practice of cardiovascular care.

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