SCAI: Team-based approach, advanced imaging key to cath lab future
Incorporating advanced digital imaging modalities and storage, team-based approaches to cardiac care and hiring health IT staff to master new technologies will likely be the wave of the future for improving the cath lab, as well as its outcomes, according to a Society for Cardiovascular Angiography and Interventions (SCAI) white paper, published Jan. 10.

Lloyd W. Klein, MD, of the Rush Medical College in Chicago, and his colleagues from the Multispecialty Occupational Health Group--a committee of physicians who represent cardiac, radiologic and electrophysiological societies--aimed to build a blueprint of what the future of interventional cath labs and vascular suites should model.

Cardiovascular (CV) programs often rely on the revenue provided from innovative diagnostic and therapeutic procedures, and the authors said opting for the latest technology plays a significant role in maintaining hospital-to-hospital competition.

The authors noted that sustainable trends in coronary heart disease will include:
  • Increased technology utilization with more frequent noninvasive imaging technology utilization as well as invasive direct vascular imaging tools;
  • Shifted case mix with fewer diagnostic catheterizations other than those likely to lead to coronary interventions and fewer acute interventions, and more elective interventions, as consequences of increased screening and improved medical therapy;
  • Earlier diagnosis and improved pathophysiologic understanding such as diagnosing vulnerable plaque before presentation as an acute coronary syndrome with newer diagnostic information integrated into the traditional angiogram in borderline and equivocal cases; and
  • Novel technical developments such as more combined or hybrid procedures. Improvements in catheter-based therapies could be expected to lead to increased caseloads, but these improvements may be offset in the longer term future by the development of better medical therapies and preventive agents.

Because vascular medicine has crossed over to various subspecialties such as interventional radiology, CV medicine and CV surgery, a team-based approach will be necessary, as will be building the proper CV suite to house these complex coronary procedures.

Particularly for electrophysiology, the authors wrote that in the future “archaic catheterization laboratories” will be replaced with sophisticated cath and ablation techniques that will focus on optimizing the visualization of the cardiac structure and fluoroscopy.

Due to the trends in reimbursement, the authors said there will also be more of a focus on imaging modalities in the cath lab. “The composition of the plaque, the presence of vulnerable plaque, its 3D geometric character, its physiologic consequence, and the simulated effect of the planned therapy will all be considered in the context of natural history and procedural morbidity, contributing to therapeutic decision making,” the authors wrote.

These imaging modalities may better assess and visualize the blood vessels and vasculature in a less cumbersome package. In addition, digital archiving and imaging will also help improve physician workflow and provide easier access to patient information.

“Integrated systems to support digital work flow, such as structured reporting tools and electronic image and report distribution systems, will define the manpower needs of the next-generation interventional laboratory,” the authors wrote.

The cath labs of the future will likely include:
  • Robotic cathether manipulation directed by advanced imaging modalities;
  • Miniaturization of therapeutic devices;
  • Use of archival solutions that make patient data easily transferable to medical professionals from multiple sources;
  • Detailed 3D reconstruction and molecular imaging techniques;
  • Utilization of virtual interfaces; and
  • IT staff that will manage the ever-changing hardware and applications to improve efficiency and eliminate disparate software and data.

“These laboratory designs are intended to enhance patient satisfaction, further increasing their competitive advantage and enhancing perceived customer value. Of course, proper utilization would require a change in medical culture, requiring a more complete team approach in which surgeons, cardiologists, and radiologists coordinate their schedules and collaborate in a truly integrated manner,” the researchers wrote.

“More than merely a cultural shift, it reflects the reality of the fields and interests merging, and traditional distinctions between the various specialties blurring.”

The researchers concluded that the future will focus on creating better patient outcomes, but to do so a team-based approach including physicians, scientists, regulators and manufacturers will be necessary to accomplish these goals.