Improving care, advancing outcomes
This week, we learn that changes in practice can help reduce cost and length of stay, while at the same time expanding care to several additional patient populations.
First, researchers from the Mount Sinai Hospital found that same-day discharge may be safe and feasible for patients who undergo uncomplicated elective PCI, when a strict set of guidelines and quality measures are upheld.
Of the over 2,000 patients analyzed, only 28 readmissions occurred within 30 days of intervention and no cases of death or major complication were reported.
Additionally, a study in JACC found that increasing or adjusting loading doses of clopidogrel, depending on platelet reactivity monitoring, can overcome platelet reactivity in patients who carry the CYP2C19 2 polymorphism, leading to a reduction of bleeding risk post-PCI.
Recently the FDA placed warnings on boxes of clopidogrel after it was found that some patients could not properly metabolize the drug, due to the CYP2C19 2 allele. Of the 411 patients enrolled in the study, 99 carried the mutant allele and 88 reached optimal platelet reactivity levels after three additional doses of clopidogrel.
And despite previous concerns that kidneys donated from cardiac-death donors pose more of a risk compared with those donated from brain-death donors, a study from the U.K. proved that use of these donor kidneys are equivalent to kidneys donated from brain-death patients.
Of the over 9,000 patients who received renal transplant via either cardiac-death patients or brain-death patients, researchers found graft survival rates to be comparable; however, cardiac-death donor kidneys ran more of a risk of obtaining delayed graft function compared to those donated by brain-death donors.
Lastly, researchers from the Rabin Medical Center in Israel found that use of drug-eluting stents (DES) during PCI sustained prognostic benefit up to five years after intervention.
In almost 7,000 patients, use of DES reduced incidence rates of MI and target vessel revascularization. Additionally, mortality was "significantly lower" in patients who were in the DES stent arm compared to the bare-metal stent arm.
"The great thing in the world is not so much where we stand, as in what direction we are moving," said Oliver Wedell Holmes, Sr., a 19th century author, professor and physician.
Despite the challenges of disease, it seems the only direction the medical industry has left to move is up.
On these topics or others, please feel free to contact me.