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Cardiac Tests & Treatments to Avoid

Cardiac Tests & Treatments to Avoid

In collaboration with the American Board of Internal Medicine’s Choosing Wisely campaign, the Society for Cardiovascular Angiography and Interventions (SCAI) has issued a list of five specific, evidence-based recommendations that should be avoided in the care of patients who have cardiovascular disease (CVD) or are at risk for it. “This list should be used to spur conversations between patients and physicians so that wise decisions are made about care based on each patient’s individual situation,” says James C. Blankenship, MD. “It’s hoped that this list will improve care for patients and eliminate unnecessary tests and procedures.” Five Recommendations for Patients with CVD The list of tests and treatments to avoid from SCAI includes the following five recommendations: 1. Avoid routine stress testing after PCI without specific clinical indications. 2. Avoid coronary angiography in post-bypass surgery and post-PCI patients who are asymptomatic or who have normal or mildly abnormal stress tests and stable symptoms that do not limit quality of life. 3. Avoid coronary angiography for risk assessment in patients with stable ischemic CVD who are unwilling to undergo revascularization or who are not candidates for revascularization based on comorbidities or individual preferences. 4. Avoid coronary angiography to assess risk in asymptomatic patients with no evidence of ischemia or other abnormalities on adequate non-invasive testing. 5. Avoid PCI in asymptomatic patients with stable ischemic CVD without the demon­stration of ischemia on adequate stress testing or with abnormal fractional flow reserve testing. The list was based on guidelines and appropriate use criteria developed by SCAI, the American College of Cardiology, the American Heart Asso­ciation, and other professional societies. All of the...
The Increasing Burden of Atrial Fibrillation

The Increasing Burden of Atrial Fibrillation

Research suggests that atrial fibrillation (AF) is the most common heart rhythm disorder, but the global burden of AF has not been estimated until recently. The World Health Organization (WHO) assesses the global burden of many public health concerns every 20 years through its Global Burden of Disease Project, but AF was not included in 1990 when the project was last conducted. To establish the global and regional prevalence of AF—in addition to its associated incidence and mortality rates—Sumeet S. Chugh, MD, FACC, FHRS, FAHA, and colleagues systematically reviewed nearly 200 population-based studies of AF. Worldwide Findings “The most important metric that WHO established for understanding the burden that a disease imposes on society is disability-adjusted life-years (DALYs),” explains Dr. Chugh. He and his colleagues found that the burden associated with AF, measured in DALYs, increased by nearly 19% in both men and women between 1990 and 2010 (Figure 1). An estimated 33.5 million men and women had AF across the globe in 2010. The estimated age-adjusted, global prevalence rates per 100,000 population increased from 569.5 in 1990 to 596.2 in 2010 for men and from 359.9 in 1990 to 373.1 in 2010 for women. In addition, the overall incidence (Figure 2) and associated mortality rates (Figure 3) increased significantly for both genders during the study period. “AF is not a condition that directly leads to death,” notes Dr. Chugh. “However, it keeps company with many heart conditions that do.” On the Local Level It is well understood that patients are getting older, not only because of the baby boomer generation but also because survival rates among patients who...
Safe Harbor for Docs  Who Follow Guidelines

Safe Harbor for Docs Who Follow Guidelines

Physician leaders are supporting a new proposed federal law that aims to reduce litigation against physicians, lower healthcare costs, and establish more fairness in the analyzing of malpractice claims. The new House bill, Saving Lives, Saving Costs Act, introduced by Congressmen Andy Barr (R-KY) and Ami Bera, MD, (D-CA) would create “safe harbor” – protection from liability – for physicians who follow best practice guidelines from malpractice suits. More than 75% of physicians face a malpractice claim over the course of their career—a liability climate that can drive patient care and encourage overutilization, adding billions of dollars in health costs each year. And patient outcomes don’t appear to improve as a result. If the physician being sued argues that he or she adhered to relevant, best practice guidelines, the case will be put in front of an independent medical review panel for investigation. If the panel determines that the clinician did comply to the guidelines or that the injury was not caused by failure to comply, the case will be dismissed. Personal injury lawyers are pushing back, one in particular claiming: “There is no evidence, however, that this safe harbor would actually promote patient safety. In fact, in Texas, where emergency room physicians have had immunity since 2003, patient safety has steadily decreased.” The Center for Justice and Democracy argues that clinical practice guidelines should not be used as a legal basis for determining negligence. The organization claims that there is already a general recognition that conflict of interest and specialty bias are ongoing problems in the development of clinical practice guidelines. Other concerns include the numerous, and sometimes contradictory, guidelines...
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