AJC: Cath labs not always prepared for obese patients

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Very obese patients pose challenges in an interventional setting and are more likely to be denied invasive coronary procedures when their weight exceeds limits established by the cath lab, according to a study published in the Aug. 1 issue of the American Journal of Cardiology.

Thomas E. Vanhecke, MD, and colleagues from the divisions of cardiology and internal medicine at William Beaumont Hospital in Royal Oak, Mich., conducted a telephone survey to determine the current weight limits of 100 U.S. cardiovascular cath labs that perform the most PCI procedures in the country. Ninety-four institutions submitted sufficient data.

The researchers said that the minimum, mean and maximum weight limits of the catheterization laboratories in this survey were 350, 437.5 and 550 pounds, respectively.

The investigators reported that 22 percent of respondents referred patients to other institutions when their patients were too heavy, and 70 percent of respondents could not provide an answer when asked what they did with the obese patients.

In this population, Vanhecke and colleagues found that 5.2 patients per hospital per year were rejected for being over the weight limit, although only 62 percent of institutions answered this question.

Vanhecke told TCTMD, that one of the most interesting things about the study was learning “the reasons that cardiac catheterization laboratories are dissuaded from doing these procedures. These include patient safety, staff safety, poor cath results and damage to very expensive equipment.”

Vanhecke also told TCTMD that he was surprised by the number of institutions that were unable to respond about their protocol for managing overly heavy patients, and the lack of strategies they had in place for dealing with the morbidly obese. “I think the most likely reason for this [uncertainty about how to manage] these patients is because the escalating . . . rates of obesity have outpaced the [capacity of the] equipment that is available.”

The authors concluded that their “results provide useful information for the future management of this growing population.”