Transradial Access: where we are

A popular hashtag among cardiologists on Twitter, #RadialFirst hopes to promote the adoption of transradial access for cardiac catheterization and percutaneous coronary intervention (PCI) in cath labs across the world thanks to a deepening evidence base of positive outcomes.

The evidence shows that transradial access is associated with reductions in bleeding, vascular complications, and time to ambulation compared with a femoral approach. However, while the adoption of the transradial approach is increasing in the United States, the approach is not as widely used as it is in Europe, Canada and Asia—perhaps due to the challenges in the approach’s learning curve.

So, what is the current state of the transradial approach in the United States? That is the question a new comprehensive literature review from the Duke Clinical Research Institute, published in Cardiovascular Innovations and Applications, set out to answer.

Continue reading Transradial Access: where we are

Stents not effective? Study sparks debate pt. 1

U.K. PCI study sparks U.S. debate

On Wednesday, November 1, results from the Objective Randomized Blinded Investigation with Optimal Medical Therapy of Angioplasty in Stable Angina (ORBITA) study were published in The Lancet.

The next day, this article was published in the New York Times:

“A procedure used to relieve chest pain in hundreds of thousands of heart patients each year is useless for many of them,” it began… “The new study, published in the Lancet, stunned leading cardiologists by countering decades of clinical experience. The findings raise questions about whether stents should be used so often—or at all—to treat chest pain.”

Without further knowledge, the debate may start right here—the New York Times article had little in the way of medical detail to satisfy invasive cardiovascular professionals and may have further generalized results in a misleading manner.

But let’s hold off on reacting, look at the debate surrounding this particular study and also place the findings in a wider context (part two). Note: this isn’t the first time it has been suggested that stents are overused.

Continue reading Stents not effective? Study sparks debate pt. 1

ACC and AHA Release 10 “Comprehensive” Measures to Combat Sudden Cardiac Death

A new joint report released today by the American College of Cardiology (ACC) and the American Heart Association (AHA) offers practitioners and stakeholders ten evidence-based quality and performance measures to prevent sudden cardiac death (SCD).

“This is the first comprehensive measure set in the area of SCD prevention,” says Sana Al-Khatib, MD, co-chair of the report writing committee in an ACC press release. “Our vision is that these measures will be developed, tested and implemented in clinical practice and that implementation will improve patient care and outcomes.”

Sudden cardiac death a “healthcare crisis”

The American Heart Association reports more than 350,000 out-of-hospital cardiac arrests (OHCA) occurring in 2016 with only 12 percent of people surviving to hospital discharge. These approximate statistics suggest more than 308,000 sudden cardiac deaths per year.

Continue reading ACC and AHA Release 10 “Comprehensive” Measures to Combat Sudden Cardiac Death

Two common ways you might misinterpret medical research

Sophisticated statistics in medical research can be hard to translate to layman’s terms, and when they are, these common misinterpretations can be downright misleading.

1. Odds ratios don’t express relative risk.

In 1999, media reports resulting from a study published in the New England Journal of Medicine wrongly suggested that black patients and women were 40 percent less likely than white patients and men, respectively, to undergo cardiac catheterization.

The study’s authors had used odds ratios to describe the significance of their findings—a common practice among statistically sophisticated researchers—which showed that black patients and women were definitely less likely to be referred for invasive procedures than white patients and men, but not how much less likely.

Continue reading Two common ways you might misinterpret medical research