Coronary angioplasty is a procedure in which arteries are opened to increase blood flow to the heart.
Patients may undergo coronary angioplasty - also called
percutaneous coronary intervention (PCI) - to alleviate chest pain or
shortness of breath. Such symptoms suggest the coronary arteries that
deliver blood to the heart are blocked or narrowed and oxygen delivery
to the heart muscle is reduced.
‘Hospitals can improve patient care and reduce costs associated with coronary angioplasty if cardiologists perform more of these procedures through an artery in the wrist and if they take steps to discharge such patients on the same day.’
Interventional cardiologists insert a
small tube into an artery in the wrist or the groin, which can be used
to view the narrowed heart artery, deliver an inflatable balloon to open
up the narrowed section, and possibly deliver a stent to hold the
Hospitals can improve patient care and reduce costs associated with
coronary angioplasty if cardiologists perform more of these procedures
through an artery in the wrist and if they take steps to discharge such
patients on the same day, revealed a new study led by Washington
University School of Medicine in St. Louis.
The research, published in JACC: Cardiovascular Intervention
suggests that the lower costs of the wrist approach largely are due to
the fact that patients experience fewer complications and can be
discharged earlier, compared with procedures that access the heart
through the larger, deeper artery in the groin. The researchers
estimated that shifting standard practice by 30% to the wrist
approach, along with same-day discharge, could save the United States
$300 million per year.
"We have unequivocal evidence and data that show better outcomes
when we access the heart's coronary arteries and perform angioplasty
through a blood vessel in the wrist rather than through the femoral
artery in the groin," said first author Amit P. Amin, an assistant
professor of medicine. "The femoral artery is the traditional route, but
when we go in through a vessel in the wrist, we see less bleeding,
fewer complications, less pain and discomfort, higher patient
satisfaction, shorter hospital stays, and lower costs."
Using the National Cardiovascular Data Registry CathPCI Registry,
the researchers analyzed data from almost 280,000 Medicare patients who
underwent PCI and were eligible for same-day discharge. Despite the fact
that all of these patients were capable of leaving the hospital the
same day as their procedures, only about 5% of these patients
actually were discharged without having stayed overnight.
"We have seen that it is very safe to send these patients home the
same day," said Amin, who treats patients at Barnes-Jewish Hospital. "We
use risk-prediction models to predict their risks ahead of time, and we
plan ahead to mitigate any issues so we can facilitate a same-day
discharge. This is really about patient care. We want to outline
health-care pathways that provide the best care for patients."
The analysis demonstrated an average cost of $13,389 for the wrist
approach with same-day discharge, compared with $17,076 for the groin
approach with at least one night of hospitalization, resulting in a cost
savings of about $3,700 for outpatients who get the wrist-access
procedure. Independent of the length of stay, the wrist approach costs
about $900 less than the groin approach, on average.
The investigators estimated that if a hospital performing 1,000 of
these procedures annually shifted 30% of these patients to the
wrist-access with same-day discharge approach, the hospital would save
$1 million over that period. Expanding that practice to hospitals
nationwide might save the United States $300 million in health-care
spending per year. Health-care costs for the 600,000 patients who
receive PCI each year in the U.S. are estimated to be $10 billion.
Of the study's patient population receiving PCI, 9% received
the procedure in which doctors used wrist access. According to Amin,
improved technology has allowed wrist access to become a viable route to
the coronary arteries, even for complex cases, and should be considered
for more patients.
"The traditional way has been to go through the bigger femoral
artery that is a straight pathway to the heart," Amin said.
"Unfortunately, that artery is also deep. It's associated with more
bleeding complications. In contrast, the wrist artery is small and is
associated with fewer complications. The minor challenge is in the
difficulty of navigating a smaller, more twisting path of an artery
through the wrist. But with advances we have in technology and
equipment, those challenges are rapidly decreasing."