Pitfalls present in PCI care

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Separate research done regarding PCI hospitals this week outlined the hurdles in the clinical administration of medications to dialysis patients and compared quality measures in low- and medium-volume hospitals with large-volume hospitals.

Although the topics are from various ends of the spectrum, the conclusions from both studies concurred that increased regard to AHA guidelines, as well as FDA warnings, could help avoid oversights, while at the same time enrich patient care.

Dr. Deepak L. Bhatt, chief of cardiology at the VA Boston Healthcare system told Cardiovascular Business that basing quality of PCI hospitals on volume should be done with caveats.

While an analysis of almost 30,000 patients found no significant correlation between hospital volume and mortality, it did find a link between volume and “quality of care measures.”

Hospitals participating in the study toiled to meet AHA and ACC guidelines for quality improvement initiatives regarding door-to-balloon (D2B) times. Also, low- and medium-volume hospitals struggled to boast comparable D2B rates to that of large-volume PCI hospitals.

Separate research by Dr. Thomas T. Tsai, director of interventional cardiology at the Denver VA Medical Center, and colleagues found that PCI hospitals wrongfully disposed two anti-thrombotic drugs to 20 percent of their dialysis patients undergoing PCI, which led to an increased risk of bleeding.

According to the data, medication blunders by clinicians are linked to 100,000 U.S. deaths per year; this includes those associated with adverse drug reactions and mistakenly administered medications.

While researchers found an increased risk of bleeding in these dialysis patients, Tsai told Cardiovascular Business News, “There is a broader message here and I think the result of this study illustrates the continued problem of medication errors in the U.S.”

Tsai urged that a system of “checks and balances” be created for clinicians in the cath lab to steer clear of administering these aforementioned drugs to dialysis patients as other alternatives do exist.

Although these drugs are contraindicated in renally-impaired patients and the FDA lists them as not recommended for use, still patients undergoing PCI with improperly functioning kidney’s are administered the drug. Tsai urged that this evidence shows that clinicians should not prescribe these drugs, and those who currently use them, should stop.

As we examine the data emerging from hospitals performing PCI, it is important to note that while technology, medical devices and procedural knowledge have advanced in the last decade, occasionally pitfalls in patient monitoring and administration of care still exist and can be improved .

As Bhatt recommended, volume should not be used as a “surrogate measure” to evaluate performance, hospitals ought to undertake AHA guidelines with regard to quality improvements, like faster D2B times, that further optimize patient care. And, as Tsai suggested, amendments to the healthcare system and health IT tools are essential to prevent avoidable medication errors.

Perhaps overall hospital review of AHA guidelines are necessary, or FDA warnings need to be bolstered, but as Bhatt concluded, perhaps “the best measure of outcome is outcome,” and that's what needs to be measured and improved.

On these or other concerns, feel free to send me questions or comments.

Kaitlyn Dmyterko
Staff Writer