Editor's Corner: Beyond the Cath Lab

The lineup of devices and drugs presented at EuroPCR never fails to impress me, and the 2015 meeting was no exception.

While attending this year’s sessions, I was reminded of how many decisions must be made during every intervention. The term “complex” could really apply across the board, not just to the most technically challenging cases. All involve taking into account the patient’s history, exposure to medications, contraindications, and lesion characteristics and unexpected findings and complications that occur along the way—not to mention the likelihood of adherence to secondary prevention after the procedure is over.

I also thought back to some recent stories on TCTMD that fall slightly outside our usual scope.

Subanalysis of the SAFE-PCI for Women trial found that women would rather have radial cath than femoral, even though standard tools for assessing quality of life fail to pick up any differences between the 2 access routes. Study after study shows that patients prefer radial.

Anecdotally, a friend whose father recently underwent radial cath describes the accumulation of evidence favoring radial “puzzling.” This man’s experience involved quite a bit of pain following the procedure, with the required hemostasis band adding to his stress and discomfort. Previous procedures via femoral access had been easier for him, she said.

He may be in the minority, or perhaps the femoral route is more painful or problematic for women than men, my friend acknowledges. Nonetheless, the apparent disconnect between research findings and personal/patient experience intrigues me. Are clinicians prone to discounting drawbacks that they do not see firsthand?

Another study, with data derived from the National Cardiovascular Data Registry CathPCI Registry, showed that 2 in 5 patients undergoing PCI in the United States who survive through hospital discharge are not referred for cardiac rehabilitation. Insurance coverage, or the lack thereof, did not matter. Patients with more urgent presentations, those who developed periprocedural MI, and those treated at higher-volume hospitals and PCI centers all were more likely to receive a referral.

Yet referral typically happens during discharge, not in the cath lab. Patients leave the hospital and often return to the care of their general cardiologist. Unless there are problems, they are unlikely to encounter their interventionalist on an ongoing basis.

So what are the responsibilities of interventional cardiologists? Where do they fall on the long continuum of prevention, treatment, and follow-up?

As a journalist—and not a physician—I wonder if these issues are on your mind. Should they take up your attention? Or are they a distraction from the more immediate needs that occur every day in the cath lab, where you are making minute-by-minute choices to ensure procedures are successful?

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