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, according to a new study led by Washington University School of Medicine in St. Louis.
Coronary angioplasty is a procedure in which arteries are opened to increase blood flow to the heart.
The research, published Feb. 20 in the Journal of the American College of Cardiology, 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 percent 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, MD, 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.”
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. 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 vessel open.
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 percent of these patients actually were discharged without having stayed overnight.
This research was published February 20, 2017, in the Journal of the American College of Cardiology.