The cardiovascular community does not have the luxury of practicing medicine by the whimsical methodology suggested by Ray Bradbury, as governing and regulatory bodies require patient care decisions that are rooted in evidence-based medicine. However, as new procedures and techniques gain approval and acceptance, individual practices and physicians need to weigh the risk and benefits to their patients.
As a relatively new procedure in the U.S., catheter ablation around the pulmonary vein region is increasingly used to treat atrial fibrillation. This week, a retrospective analysis was released in JACC, assessing the mortality risk associated with the prodedure, based on data from 546 electrophysiology (EP) centers worldwide. The researchers discovered that one in 1,000 a-fib patients treated with catheter ablation die.
Based on this data, Dr. Bernard Belhassen, who wrote the accompanying editorial, asked whether this mortality rate is an "acceptable risk" for this patient population--a question that should be considered by those designing more appropriate and efficient EP settings.
When assessing risk, hospital administrators also need to consider the recent statistics released by the AHRQ about preventable hospitalizations. In 2006, nearly 4.4 million hospital admissions, totaling $30.8 billion in costs, could have been potentially preventable with timely and effective ambulatory care or adequate patient self-management, according to the agency. Of no surprise to those in the hospital setting, the data also revealed that congestive heart failure was the most common reason for potentially preventable hospitalizations, accounting for $8.4 billion of the total hospital costs.
Even Congress is seeking to address risk assessment in the hospital setting through a bill introduced to provide for a program of quality measurement and reporting and for the use of performance-based payment within Medicare for inpatient services. The legislation would require the HHS secretary "to select appropriate evidence-based and statistically valid quality measures of care furnished by hospitals in inpatient settings for evaluating hospital performance."
While the medical community has to approach patient management in a reasonable manner, Bradbury's more carefree approach could also nudge those who are resistant to any change in methodology, when the evidence points to conclusive positive outcomes.
On these topics, or any others, please feel free to contact me.
Justine Cadet, News Editor