Even With Stent Cards, Patients Often Hazy on PCI Details Years Later

Those flimsy, wallet-sized pieces of paper that detail the type, size, and location of the stent implanted? After roughly 4 years after device implantation, just under half of patients still carry their stent card, according to a new study.

And even among those diligent card-carrying members of the coronary stent club, patients had very little knowledge about the device propping open their arteries. In fact, only 17% of patients with a stent card were able to correctly identify the date of the procedure, the vessel stented, and the type of stent they received, say researchers.

For one cardiologist, the continued reliance on paper stent cards doesn’t make much sense. Computers, cellular phones, and app-based technology would go a long way toward eliminating the need for patients to carry around the card, especially since half aren’t doing so anyway. 

“Coronary stents have been around for a while, and although the technology for stents and iterations of the different devices keeps on changing, we still just give patients the same paper card,” lead author Jordan Safirstein, MD (Morristown Medical Center, NJ), told TCTMD. “I mean, I have a screen shot of a patient’s Palmaz-Schatz stent card from 1995, and that card is no different from 2021 when someone gets a stent. It’s the same exact paper card for their wallet.”

More Often Wrong Than Correct

In terms of PCI outcomes, it’s not known if a patient’s knowledge about their procedure or device makes a significant difference over time, Safirstein said, even if intuitively, they should know the details about a piece of metal implanted in their coronary arteries. For this research, however, the group simply wanted to evaluate patient knowledge about their most recent procedure and to learn how many still kept the original stent cards on them.

Safirstein said that while 48% of patients still had the card in their possession a median of 4 years later, which was higher than he expected, carrying the stent card didn’t provide much help. In the entire survey, which is slated for presentation on May 17 at the American College of Cardiology 2021 Scientific Session, just 11% of 313 patients with a history of PCI knew the date of their procedure (month/year), the vessel stented, and type of stent received (DES vs BMS).

Moreover, said Safirstein, “it didn’t even really matter if they had the card or not. The answers to those questions were not very often correct. In fact, even if they had the card, less than 20% of patients could answer all three questions correctly. If they didn’t have the card, only 3% got all three questions correct.”

Deepak L. Bhatt, MD, MPH (Brigham and Women’s Hospital, Boston, MA), who wasn’t involved in the study, agreed that it would be out of the ordinary for patients to know the details of their procedure. “It would be very unusual for a patient to say, ‘I have a drug-eluting stent in my mid-left circumflex artery,’” he told TCTMD. “The best I have seen, even from very educated and medically savvy patients, is they’ll know they have a stent in their heart arteries, or a couple of stents. Beyond that, it would be very unusual to name the actual artery.”

Bhatt said that physicians and nurses, in the past, always made sure that patients were provided a stent card prior to discharge but he isn’t certain the protocol is followed as strictly today.

“We still do it, but it doesn’t seem to be done with the same passion and I’m not sure what has really led to that change,” said Bhatt. “Maybe it’s the feeling that stents are all the same or the safety profile is so good that we’re less worried about late and very late stent thrombosis, unlike with the Taxus stent where we were much more worried about that phenomenon. In general, I think it’s still the right thing to give the patient the stent card. For any implantable device, they should have that card and have it with them at all times.”

He noted that electrophysiologists are much more diligent in making sure patients carry information about their implantable cardioverter-defibrillators, pacemakers, or cardiac resynchronization devices. Information about the stent location would be relevant for emergency department physicians or others without immediate access to the patient’s electronic medical records, said Bhatt. In the catheterization laboratory, operators can visualize the stents on fluoroscopy, though may not know the exact diameter or brand of stent without access to the patient’s medical records or stent card.  

Photos and Cell Phones

One trick in the modern era is to take a photo of the stent card so that patients have an image of the stent card available even if they might not be carrying their wallet, said Bhatt. They could upload the photo to the “cloud” so it’s accessible if they switch phones or change plans, he said. “The wallet or purse isn’t quite what it used to be, but having a saved photo of it is good enough,” said Bhatt. “I think there’s still value in that.”

As part of the study, Safirstein and colleagues asked patients about a willingness to use their mobile phones for accessing information about their stent. In total, 87% of patients had their phone on them and more than 75% were willing to use their phone for healthcare purposes. When excluding patients older than 80 years, roughly 90% of patients had their phone on them and were willing to use it for healthcare.

“If they were in the emergency room and didn’t have their stent card, but they had their phone, that seems like a much more durable and reliable way to carry that information,” said Safirstein.

Like Bhatt, he tells patients to take a photo of the stent card so that the information is readily available, but suspects a dedicated phone-based app might be better able to host the stent information. He envisions scanning the device’s bar code so that stent size and serial number could be imported to the phone, along with an invitation to download an app that would allow them to input other needed information. 

“Most of us live a lot of our lives on the phone,” he said. “We do banking on the phone, we book travel on the phone, we buy coffee on the phone—all these daily tasks we’re accomplishing on the phone, and yet we have no record of what somebody put inside our body. . . . It seems like a very easy shift to do, especially in the era of the Cures Act where we’re trying to empower patients to be part of medical decision. They should have this information at their fingertips and with them at all times.”

For interventional cardiologists, said Safirstein, it might be important to know the details of a previous procedure when taking patients for another PCI, because it affects subsequent choices. If physicians are treating a patient for in-stent restenosis, they’d likely avoid the same type of stent with the next procedure. If patients return to the same hospital or one within the same healthcare system, accessing the information about a previous device is easy. If the patient is from out of state, though, a way to access all the stent information becomes quite valuable, said Safirstein.

Justin Levisay, MD (NorthShore University HealthSystem, Evanston, IL), also commenting on the study for TCTMD, said that he’s seen “hundreds of dog-eared, worn-out stent cards pulled out of wallets,” noting that patients, in his experience, tend to hang on to them. “I find it reassuring,” Levisay said. While patients might not be able to tell him where the stent was placed or its size, the stent card “tells me all I need to know.”