In mid-November, the question of whether hospitals without on-site cardiac surgery should offer elective angioplasties rose to the surface as the American College of Cardiology issued revised guidelines for percutaneous coronary intervention and the American Hospital Association released a new study on angioplasty. The American College of Cardiology Foundation's revised guidelines for PCI suggested that hospitals without surgical backup could safely perform angioplasty if certain criteria were met. The study analyzed data from the Cardiovascular Patient Outcomes Research Team trial and found that patient outcomes were no different for hospitals with and without on-site cardiac surgery.
The topic of angioplasty at hospitals without cardiac surgical backup was also discussed at the local level, with at least two hospitals pushing to offer the service and meeting resistance. Plans by Doctors Hospital of Sarasota (Fla.) to provide angioplasty and stenting despite lacking on-site cardiac surgery sparked opposition by the hospital's physicians and nurses who argued there were insufficient staffing and training to safely perform the procedure. Meanwhile, Huntsville (Ala.) Hospital opposed plans by Crestwood Medical Center in Huntsville to make its angioplasty program permanent, contending that the ACC did not fully advocate for angioplasty at non-heart surgery hospitals and that the community did not have a need.
Here, Jason Freeman, MD, director of interventional cardiology at South Nassau Communities Hospital in Oceanside, N.Y., discusses the debate and how South Nassau developed its angioplasty program.
History
Dr. Freeman says hospitals without on-site cardiac surgery have long been known to safely offer angioplasties if they meet certain conditions. "The truth is, this is nothing new. We've known since the late 1990s that people presenting with heart attacks and requiring emergency angioplasty did just as well when presented to community hospitals, as long as they had catheterization laboratory facilities and experienced operators, than if they presented to hospitals with on-site surgery," he says. In fact, survey results from U.S. News & World Report and theheart.org found two-thirds of cardiologists said angioplasties can be performed safely and effectively without on-site cardiac surgery
In 2000, South Nassau joined the C-PORT study and became one of the first hospitals in New York to offer emergency angioplasty without surgical backup for cardiology patients. In 2006, based on its success with emergency angioplasties, South Nassau became one of the first hospitals in New York to offer elective angioplasty without surgical backup.
Requirements
Hospitals without cardiac surgical backup that want to offer PCI have to have an operating cath lab and an experienced interventional cardiologist available 24/7/365, Dr. Freeman says. The hospital also has to meet specific volume requirements set by the ACC or state. The C-PORT trial, for example, required hospitals to perform at least 200 PCI cases annually and that physicians performing the procedure did more than 75 PCI cases annually.
"Not only is it a big expense for the hospital to try and start up a program like that, but it also takes a lot of time to get up to procedural volume that you would need to maintain a program," Dr. Freeman says.
Benefits
South Nassau decided to offer angioplasty to increase the community's access to this procedure, according to Dr. Freeman. This increased access has resulted in high satisfaction among patients electing for PCI. "They are so appreciative they get to come to their community center and see their doctor, friends and family are able to visit them and they are in a familiar area. Their experience is completely different than when they go to a hospital center they've never been in," Dr. Freeman says. In fact, he says the introduction of elective PCI at South Nassau led to near constant letters from patients thanking the hospital for this service.
Dr. Freeman says one of the reasons why South Nassau and other hospitals without on-site cardiac surgery have success with angioplasty and PCI is technological advancements over the years — from the introduction of stents around 1993 to recently developed drug-eluting stents. "[Due to] improvements in technology and pharmacology, the procedure itself is so much safer that [the need for] emergency bypass surgery is .1-.3 percent now," Dr. Freeman says. "It's so low that PCI can be done very safely in centers without on-site cardiac surgery."
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The topic of angioplasty at hospitals without cardiac surgical backup was also discussed at the local level, with at least two hospitals pushing to offer the service and meeting resistance. Plans by Doctors Hospital of Sarasota (Fla.) to provide angioplasty and stenting despite lacking on-site cardiac surgery sparked opposition by the hospital's physicians and nurses who argued there were insufficient staffing and training to safely perform the procedure. Meanwhile, Huntsville (Ala.) Hospital opposed plans by Crestwood Medical Center in Huntsville to make its angioplasty program permanent, contending that the ACC did not fully advocate for angioplasty at non-heart surgery hospitals and that the community did not have a need.
Here, Jason Freeman, MD, director of interventional cardiology at South Nassau Communities Hospital in Oceanside, N.Y., discusses the debate and how South Nassau developed its angioplasty program.
History
Dr. Freeman says hospitals without on-site cardiac surgery have long been known to safely offer angioplasties if they meet certain conditions. "The truth is, this is nothing new. We've known since the late 1990s that people presenting with heart attacks and requiring emergency angioplasty did just as well when presented to community hospitals, as long as they had catheterization laboratory facilities and experienced operators, than if they presented to hospitals with on-site surgery," he says. In fact, survey results from U.S. News & World Report and theheart.org found two-thirds of cardiologists said angioplasties can be performed safely and effectively without on-site cardiac surgery
In 2000, South Nassau joined the C-PORT study and became one of the first hospitals in New York to offer emergency angioplasty without surgical backup for cardiology patients. In 2006, based on its success with emergency angioplasties, South Nassau became one of the first hospitals in New York to offer elective angioplasty without surgical backup.
Requirements
Hospitals without cardiac surgical backup that want to offer PCI have to have an operating cath lab and an experienced interventional cardiologist available 24/7/365, Dr. Freeman says. The hospital also has to meet specific volume requirements set by the ACC or state. The C-PORT trial, for example, required hospitals to perform at least 200 PCI cases annually and that physicians performing the procedure did more than 75 PCI cases annually.
"Not only is it a big expense for the hospital to try and start up a program like that, but it also takes a lot of time to get up to procedural volume that you would need to maintain a program," Dr. Freeman says.
Benefits
South Nassau decided to offer angioplasty to increase the community's access to this procedure, according to Dr. Freeman. This increased access has resulted in high satisfaction among patients electing for PCI. "They are so appreciative they get to come to their community center and see their doctor, friends and family are able to visit them and they are in a familiar area. Their experience is completely different than when they go to a hospital center they've never been in," Dr. Freeman says. In fact, he says the introduction of elective PCI at South Nassau led to near constant letters from patients thanking the hospital for this service.
Dr. Freeman says one of the reasons why South Nassau and other hospitals without on-site cardiac surgery have success with angioplasty and PCI is technological advancements over the years — from the introduction of stents around 1993 to recently developed drug-eluting stents. "[Due to] improvements in technology and pharmacology, the procedure itself is so much safer that [the need for] emergency bypass surgery is .1-.3 percent now," Dr. Freeman says. "It's so low that PCI can be done very safely in centers without on-site cardiac surgery."
Related Articles on Hospitals and Angioplasty:
Crestwood Medical Center, Huntsville Hospital in Alabama Bring Angioplasty Battle to HearingMost Cardiologists Say Hospitals Without Surgery Can Offer Angioplasty
FL's Doctors Hospital of Sarasota Dismisses Physicians' Concerns, Prepares to Offer Stenting