TAVR Volume Requirements Spark Continued Debate

CMS considers changing TAVR volume requirements

CMS Considers Changing TAVR Volume Requirements

Debate over transcatheter aortic valve replacement (TAVR) procedures continues as the Centers for Medicare and Medicaid Services (CMS) considers changing the status quo. Are TAVR volume requirements limiting rural and minority access to this life-saving procedure, or are they still necessary for patient safety?

In June 2018, cardiology news sources widely reported that CMS opened public comment on established volume requirements for hospitals and heart teams to perform TAVR. The Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) then met on July 25 to discuss the issue. A report in Cardiovascular Business suggested that the committee appeared split on the subject—especially in weighing the potential harms of limiting TAVR to only high volume hospitals.

Cases for and against TAVR volume requirements

The Case for TAVR Volume Requirements

For those on the side of maintaining TAVR volume requirements, the benefits are obvious—volume is associated with positive outcomes and lower rates of complications. In fact, a 2018 expert consensus document from four major cardiology societies actually supported increasing volume requirements to maintain a TAVR program, to ensure adequate data collection for statistically reliable quality metrics and quality assurance.

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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.

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Taylor Swift in the Cath Lab? Music in the Cath Lab Debate

Does music play during procedures in your lab? Who chooses the music?

A recent study published in the Aesthetic Surgery Journal found that “when plastic surgeons listen to music they prefer, their surgical technique and efficiency when closing incisions is improved,” says a University of Texas Medical Branch press release.

While many studies have been conducted supporting the idea that music reduces stress and promotes efficiency for operating room staff, this study adds to a more limited evidence base that suggests music can improve technical performance and speed of a procedure.

Why does it matter? Reducing the time of a procedure can lead to significant cost savings, of course, and in cardiac emergencies where “time is muscle,” promoting procedure efficiency is key to providing quality care.

But should the cardiologist control music in the cath lab?

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