www.scai.org www.seconds-count.org
May/June 2009
The Society for Cardiovascular Angiography and Interventions
SCAI Guides Physicians on Length-of-Stay Decisions
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new SCAI consensus paper has for the first time established recommendations for patient hospital stays following elective percutaneous coronary interventions. The paper, “Defining the Length of Stay Following Percutaneous Coronary Intervention,” analyzes peer-reviewed studies to determine which patients can be sent home safely the same day versus those who should be hospitalized for longer periods of observation. “It’s not always clear which patients should be kept overnight or admitted to the hospital, and which patients can safely return home the same day,” said senior author Carl L. Tommaso, M.D., FSCAI, associate professor of medicine at Rush University Medical
SAVE THE DATE SCAI 33rd Annual Scientific Sessions
May 5–8, 2010
Hilton San Diego Bayfront
San Diego, California
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SCAI Launches Women in Innovations Group
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eart disease is the number-one killer of women. Yet, as interventional cardiologist Roxana Mehran, M.D., FSCAI, of Columbia University Medical Center, points out, the number of women enrolled in cardiovascular clinical trials is quite low. Also low is the number of female interventionalists. Now Dr. Mehran and other women cardiologists around the world are working to boost those numbers. At the Society’s Annual Scientific Sessions in May, they officially launched a new SCAI initiative called Women in Innovations (WIN). The goal? To improve women’s treatment by giving female interventionalists around the world a space of their own. “We want women to know they have a place in Interventional Cardiology and to feel there’s a home for them,” says Dr. Mehran. Dr. Mehran serves on the new Roxana Mehran, M.D., organization’s executive committee FSCAI
along with Bonnie H. Weiner, M.D., MBA, MSEC, FSCAI, of St. Vincent Hospital in Worcester, MA, and Alaide Chieffo, M.D., of San Raffaele Hospital in Milan, Italy. WIN’s goals are threefold: • Increasing professional development opportunities. Ask successful female interventionalists what has made a difference in their careers, says Dr. Mehran, and the answer will be the same: mentorship. To help connect early-career interventionalists with more established women or men, WIN plans to create a mentorship program and an exchange program for fellows-in-training worldwide. • Providing education. WIN plans to organize symposia on women’s issues at major cardiovascular meetings around the world and cosponsor women’s programs and initiatives that are already in place. Over the long run, WIN also plans to develop a menu of educational programs and a roster of speakers.
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SCAI Consensus Statement (cont’d from pg 1) School and director of the cardiac catheterization laboratory at Skokie Hospital in Chicago. “The goal of this document is to guide physicians making decisions for follow-up care after an elective PCI. Ultimately, the physician should make the decision based on the patient’s specific condition and the criteria Carl L. Tommaso, M.D., FSCAI outlined in this paper.” The paper was unveiled at SCAI’s Annual Scientific Sessions in Las Vegas, NV, in May and published in Catheterization and Cardiovascular Interventions. Dr. Tommaso’s co-authors include Charles E. Chambers, M.D., FSCAI, Gregory J. Dehmer, M.D., FSCAI, David A. Cox, M.D., FSCAI, Robert A. Harrington, M.D., FSCAI, Joseph D. Babb, M.D., FSCAI, Jeffrey J. Popma, M.D., FSCAI, Mark A. Turco, M.D., FSCAI, and Bonnie H. Weiner, M.D., MSEC, MBA, FSCAI. In the past, patients typically spent two days in the hospital following an elective PCI. But recent advances have cut the standard stay to one day, and changes in insurance reimbursement have put pressure on hospitals to send more patients home the same day as the procedure. “When you think about how young our specialty is and the tremendous advances we’ve made with interventions in such a short time, it’s remarkable that we’re even discussing same-day discharge after a heart procedure,” said Dr. Chambers, who is director of interventional cardiology at Penn State Hershey Charles E. Chambers, Heart and Vascular Institute. “While M.D., FSCAI the possibility of a short hospital stay is a true benefit of PCI procedures and a testament to how far we’ve come, it’s still important that we examine each patient’s situation carefully before sending them home.” The consensus statement warns that the trend toward shorter stays could jeopardize the health of some at-risk patients. To help doctors and health care facilities determine an appropriate length of stay for each patient, the authors created a detailed decisionmaking matrix that accounts for numerous patient risk factors. The paper groups elective PCI patients into four categories: those who can be sent home within 12 hours (outpatient); those who require a stay of between 12 and 24 hours (observation); those who require more than 24 hours (extended observation); and those who require inpatient admission.
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“While the possibility of a short hospital stay is a true benefit of PCI ... it’s still important that we examine each patient’s situation carefully before sending them home.” ~Dr. Chambers
SCAI News & Highlights is published by
The Society for Cardiovascular Angiography and Interventions 2400 N Street, NW, Suite 500, Washington, DC 20037 Phone 800-992-7224; Fax 202-689-7224 www.scai.org; www.Seconds-Count.org; info@scai.org Steven R. Bailey, M.D., FSCAI, President Larry S. Dean, M.D., FSCAI, President-Elect Ziyad M. Hijazi, M.D., MPH, FSCAI Immediate Past President Morton Kern, M.D., FSCAI, Editor-in-Chief Norm Linsky, Executive Director _____________________________________________________ Sandra Baxter Surveys and Needs Assessment Kerry O’Boyle Curtis Education, Meetings, and Communication Kathy Boyd David Managing Editor Ryan Donnells Database, IT, and Accounting Eric Grammer Marketing Kim Greene Meetings Joel Harder Quality Initiatives and Clinical Documents Rick Henegar Meetings Andrea Hickman Meetings Mary Hogan Membership Dawn Hopkins Advocacy Sarah Jones Operations and Administration Terie King Accounting and Finance Kimberly Martin Committee Operations Wayne Powell Advocacy and Guidelines Beatrice Reyes Operations Betty Sanger Sponsorship and Development Rebecca Teichgraeber Education Kim Watkins Accounting MultiWeb Communications Online Services touch three Design and Production Imaging Zone Printing
CME
From SCAI And partners SCAI-Cosponsored ProgramS
12th Annual Live Symposium of Complex Coronary & Cardiovascular Cases Date: Sponsor:
SCAI-Sponsored Programs
To register for any of these programs, contact Rebecca Teichgraeber at rebeccat@ scai.org or 800-992-7224.
2009 SCAI FALL INTERVENTIONAL CARDIOLOGY FELLOWS COURSE Date: December 7–11, 2009 Location: Las Vegas, NV Directors: Michael J. Cowley, M.D., FSCAI, Bonnie Weiner, M.D., MBA, MSEC, FSCAI, and Christopher U. Cates, M.D., FSCAI
June 17–20, 2009 Mount Sinai School of Medicine Location: New York, NY Course Directors: Samin K. Sharma M.D., FSCAI, and Annapoorna S. Kini, M.D. For more info: www.cccsymposium.org
PICS~AICS 2009- Pediatric & Adult Interventional Cardiac Symposium Date: Sponsor:
June 21–23, 2009 PICS~AICS 2009- Pediatric & Adult Interventional Cardiac Symposium Location: Cairns, Australia Course Directors: Ziyad M. Hijazi, M.D., MPH, FSCAI, William E. Hellenbrand, M.D., FSCAI, John P. Cheatham, M.D., FSCAI, Carlos Pedra, M.D., and Geoffrey Lane, MBBS For more info: www.picsymposium.com
CICT Date: Sponsor:
July 31–August 2, 2009 Conference Management Solutions, LLC Location: San Francisco, CA Directors: Issam D. Moussa, M.D., FSCAI, and Joseph De Gregorio, M.D. For more info: www.cict2009.org
ACCF/SCAI PREMIER INTERVENTIONAL CARDIOLOGY OVERVIEW AND BOARD PREPARATORY COURSE Date: Sponsor:
Aug. 21–23, 2009 American College of Cardiology Foundation Location: Dallas, TX Directors: Joseph D. Babb, M.D., FSCAI, FACC, and James E. Tcheng, M.D., FACC, FSCAI For more info: www.acc.org/ivboard
Innovations in Cardiovascular Interventions Date: Dec. 7–9, 2009 Location: Tel Aviv, Israel For more info: email rebeccat@scai.org
Women in Innovations (cont’d from pg 1) • Improving research. When WIN members reviewed the literature on cardiovascular clinical trials, they discovered that women typically represent less than a third of trial participants. That’s not acceptable, especially when it comes to medical devices, says Dr. Mehran. “While devices are being approved for the general population and being placed in women, do we actually have enough data to say that they’re just as safe and effective in women?” she asks. WIN hopes to establish a new standard that would ensure that enough women are enrolled in trials to prove safety and efficacy in women as well as men. Other goals include writing a white paper on gender disparities in cardiovascular disease and establishing a worldwide registry on a niche topic, such as bleeding in women who have undergone percutaneous coronary interventions. As the group’s name suggests, WIN will also promote innovation by women interventionalists. “We want to lift the obstacles for women who can think outside the box,” says Dr. Mehran, citing the difficulties that anyone—but especially women—face in winning a patent. “We want to provide a forum for coming up with ideas and then a support group for providing the kind of resources that are needed to bring an idea to fruition.” In the meantime, WIN’s members are busily laying the groundwork. They’re beginning to think about how to pursue grant funding and perhaps launch a clinical trial to examine gender differences in clinical outcomes.
They’re creating an advisory committee they hope will be peopled by representatives from industry, the U.S. Food and Drug Administration, the Office of Women’s Health, and other organizations.
A Global Emphasis “WIN won’t be restricted to American female interventional cardiologists,” emphasizes Dr. Mehran. “It will be a truly global initiative.” To help achieve that goal, WIN is recruiting “ambassadors” from various regions. These regional ambassadors will encourage women interventionalists in their areas to join WIN, identify opportunities for regional symposia, and determine local needs. WIN has already named ambassadors for Central and South America, Europe, the United Kingdom, Australia, Canada, and the United States. So far, says Dr. Mehran, the response has been very positive. “SCAI has accepted us with open arms,” she says. And the enthusiasm goes both ways, she adds. “It’s unbelievable the number of women who are out there that we didn’t even know about,” she says, adding that men who support WIN’s mission are also welcome. “All of them want to be connected to a society that supports such a great initiative.” For more information about WIN, contact Rebecca Teichgraeber at rebeccat@scai.org or 202-741-9872. Or visit www.scai-win.org n
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In the Trenches Navy Cardiologist Goes Civilian With Honor, Courage, and Commitment the National Naval Medical Center in Bethesda, MD. Throughout his Navy career, he always enjoyed teaching and gaining experience from responsibilities typically assumed much later in the careers of civilian cardiologists. In San Diego, he directed the cath lab and served as an ACC Governor. “The work ethic and the training I got in the Navy have been outstanding,” he said. “I would do it again in a second.” He also credits his family, friends, and mentors for “keeping him in line,” and teaching him life’s most important lessons. Whenever someone took him aside and said “you can do this better,” he did. Dr. Cavendish has little time for hobbies, but he makes time to coach his four kids in sports.
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very day, Jeffrey Cavendish, M.D., FSCAI, strives to become the best at what he loves to do—care for patients. And for him, that’s more than just a personal goal, it’s a responsibility. “I hold myself to a very high standard because we’re not dealing with trivial decisions; we’re dealing with real life-and-death situations.” Dr. Cavendish is an interventional cardiologist for Kaiser Permanente in San Diego. Just this past June, he left the Navy after a successful 14-year career, persuaded to pursue a “great opportunity” at Kaiser so he could “see more patients and do more interventional procedures.” At Kaiser he is one of five interventionalists in a group of 21 providers. “Kaiser is a huge organization with a half-million patient population in San Diego.” They do about a thousand coronary interventions a year. “It was a big change, but I couldn’t be happier,” he says. “I’m very fortunate to wake up every morning looking forward to seeing patients, practicing cardiology, and working in the cath lab.” “I enjoy talking to patients, getting to know them, helping them.” Whether it’s taking patients to the cath lab for an angioplasty, adjusting their medications, or telling them they’re “good to go,” Dr. Cavendish loves the clinical aspects of seeing patients. He believes that the patient is the most important part of practicing medicine.
Life-Long Dream According to his parents, Dr. Cavendish always wanted to be doctor. “I remember learning about the circulatory system in fourth grade and being fascinated by it.” But money was tight, so he worked through college and went to medical school at Georgetown on a Navy scholarship. After medical school, Dr. Cavendish did his internal medicine residency and served as chief resident at
Core Values Although Dr. Cavendish has left active duty service, he remains in the U.S. Navy Reserves and his personal and professional practices still reflect the Navy’s core values of honor, courage, and commitment. He’s been married for 18 years. “I’m more in love with my wife now than I was 20 years ago when we met.” He laughs when asked about hobbies, but he always makes time to coach his four kids in sports. “The focus on my family was the main reason I stayed in San Diego—they just love it here.” Professionally, he’s committed to providing great care and improving “quality in Interventional Cardiology, specifically, but also the overall community in San Diego.” In the Navy, he told fellows, “It’s not ‘Can we do this?’; it’s ‘Should we do this?’” His approach at Kaiser is the same: “If you’re always doing what you think is best for the patient in the long run, then you really can’t go wrong.” “The technology has advanced so much that we can do just about anything.” So now more than ever he believes that interventional cardiologists need good organizations, such as SCAI, to promote excellent education and quality. “We are the future of Interventional Cardiology.” Involved with SCAI since he became a fellow, Dr. Cavendish has worked on the Education and Interventional Career Development Committees. At present, he’s working with other committee members to write the Society’s position paper on ethics. “I encourage every young interventionalist to join SCAI,” says Dr. Cavendish. SCAI serves the “the Interventional community as a whole,” giving it a voice. “Where it goes and how it gets there depends on keeping interest and enthusiasm alive.” That shouldn’t be difficult, because it is an exciting time to be an Interventional Cardiologist, says Dr. Cavendish. “I feel blessed to be living my dream and doing what I love every day.” And, according to his nurse at Kaiser, he’s not the only one—his patients are happy, too. n
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SCAI Launches Regional Educational Program for Non-Interventionalist Providers
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CAI recently concluded pilot testing of a new community outreach education program directed primarily to general cardiologists and primary care physicians. The Know What Counts program is one of the Society’s SCAI Cares regional initiatives intended to bring cutting-edge Interventional Cardiology knowledge and clinical trial results to interventionalists’ partners in caregiving. The key elements of Know What Counts include collaboration with local and regional medical groups to recruit physicians in the two groups, presentations by leading interventionalists in a variety of educational formats, and a comprehensive evaluation to learn how the program is received and what changes attendees make in their practice patterns in the months following a program. Attendees are asked to respond to questions based on several clinical vignettes before each program to ascertain their decision-making skills and knowledge. They are followed up by telephone three months and again six months later and given similar vignettes to consider. The evaluation results so far indicate increased and retained knowledge about outcomes comparing PCI vs. CABG and competence in discussing the pros and cons of each procedure with patients. Findings also confirm retention of guidelines-based practices regarding dual antiplatelet therapy following implantation of drug-eluting stents.
the San Antonio Cardiovascular Society, and internists, residents, and fellows at Brooke Army Medical Center.
Next Stop, New Orleans In November 2008, SCAI offered a Know What Counts pilot presentation as a satellite event during the American Heart Association Annual Scientific Sessions in New Orleans. Forty-one physicians, mostly general and interventional cardiologists and mid-level providers, listened to three presentations: the same two delivered in San Antonio plus a new one on PCI in women, by SCAI Trustee Roxana Mehran, M.D., FSCAI. The evaluation data showed all three presentations were well-received and new information gained and retained. Knowledge Gaps Apparent From Pre-program Evaluations In both pilot sites, the pre-program evaluations documented knowledge gaps among attendees. As expected, further analysis revealed that the responses were heavily dependent on the attendee’s subspecialty. Looking for a Few Good Sites SCAI plans to conduct additional Know What Counts programs this year. A schedule of programs will be posted on www.SCAI.org. SCAI members who wish to nominate their cities as candidates for programs are invited to do so by contacting Kerry Curtis at kcurtis@scai.org. n
Inaugural Program Held in San Antonio In late summer 2008, SCAI kicked off the first pilot program Analysis of the Pre-Event Data in San Antonio. Then SCAI % San % San % New President-Elect Steven R. Bailey, Antonio Antonio Orleans 3-month Pre-event Pre-event M.D., FSCAI, and Immediate Follow-up Combined Combined Past President Bonnie Weiner, Case 1: A 53-year old woman presents with complaints of occasional chest pain and shortness of M.D., MSEC, MBA, FSCAI, breath. She has multiple risk factors. Her stress test shows moderate ischemia. delivered presentations on A. What would you do? optimizing clinical outcomes 0% 13% Start medical therapy 57% • 15 26 and stable angina, including 3 • Assess risk factors 0 13 17 • Refer to a cardiologist analysis of data from COURAGE, 50 39 0 • Conduct a stress test 15 0 SYNTAX, and other relevant –not asked– • Refer for a diagnostic catheterization 20 9 23 • All of the above clinical trials. Their audiences included family practitioners at B. An imaging stress test shows minimal ischemia. Christus Santa Rosa Hospital, What would your next approach be? 0% 0% 0% Nothing • cardiothoracic surgeons and 40 48% 0 • Continue current medical therapy medical students at the University 55 43 57 • Optimize medical therapy 5 9 34 • Refer for diagnostic catheterization of Texas Health Sciences Center, 0 0 9 • Perform CT angiogram general cardiologists and mid T he San Antonio follow-up data demonstrate that the programs increased the likelihood of appropriate referrals, level providers at an evening of correct interpretation of symptoms, and of better understanding the risks and benefits of CABG vs. PCI. symposium co-sponsored with
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Advocacy & Guidelines Interventionalists Favor Health Care Reform, Says SCAI Survey As President Barack Obama and Congress prepare to overhaul the nation’s health care system, a new SCAI survey shows that Interventional Cardiologists strongly support health care reform and finding ways to make health care more affordable and accessible. But the survey also reveals deep concerns over what the coming changes could mean for both patient outcomes and the future of the subspecialty. SCAI commissioned the January survey of 5,056 members and attendees of SCAI educational programs to help shape the Society’s advocacy efforts at a critical time in the national health care debate, said Mark A. Turco, M.D., FSCAI, who chairs Mark A. Turco, M.D., the Advocacy Committee with FSCAI Joseph D. Babb, M.D., FSCAI, and Co-chair Carl Tommaso, M.D., FSCAI. “We wanted to be able to take the survey data to lawmakers and the public and say, ‘These are the concerns from leading Interventional Cardiologists from around the country as they apply to the delivery of cardiovascular care,’” said Dr. Turco, director of the Center for Cardiac & Vascular Research at Washington Adventist Hospital in Takoma Park, MD. The survey results offer a snapshot of Interventional Cardiologists’ views on key public policy issues. Like most online surveys, the response rate was low and the findings were not statistically significant, but they reflected the opinions of SCAI’s diverse membership in terms of work setting and length of time in the field. SCAI advocacy will be more effective if it is guided by the views of a larger number of interventional cardiologists, Dr. Turco said. “In today’s climate, it’s absolutely imperative that we issue a call to arms to all of our members. Interventional Cardiology has a big bull’s-eye on its back because we are perceived as big users of expensive technology. It’s important for us to be part of the reform discussion,” he said.
“It’s critical that we influence the discussion on comparative effectiveness to balance it in favor of patient care and safety, not just cost.” ~ Dr. Turco The President wants major changes to the country’s patchwork health care system. Survey respondents overwhelmingly supported his goals of affordability and expansion of coverage, with 42 percent saying his top health care priority should be affordability, and 37 percent saying his top priority should be expanded coverage for the uninsured. President Obama plans to pay for the expansion in part by reducing health care costs. A plurality of survey respondents, 41 percent, said the focus on cost-effectiveness would not lead to better patient outcomes, while 24 percent said it would. And a plurality of survey respondents – 43 percent – said they expected the President’s plans would likely restrict patient access to subspecialty care like Interventional Cardiology, compared with 23 percent who said it would have no impact. Just 14 percent said it would expand patient access. Survey respondents also expressed deep concern about the President’s support for comparative effectiveness analysis of medical treatments – if the goal is simply to reduce costs. Three of four survey respondents – 77 percent – said the concept would limit patient access to needed treatments, and 73 percent said it would limit development of new drugs and devices. “It’s critical that we influence the discussion on comparative effectiveness to balance it in favor of patient care and safety, not just cost,” Dr. Turco said. “If members are concerned about this – and they clearly are – they have to participate in the process to get their perspective across. The interventional field has always been driven by evidence. We need to help government agencies design research that has appropriate endpoints and ask important questions. Otherwise, we might find
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out that the comparative trials lead to outcomes that will prevent us from delivering the best possible care to all our patients.”
Join SCAI’s Vital Signs SCAI recognizes that Interventional Cardiologists are busy, and that email traffic has grown exponentially in recent years. Nevertheless, SCAI considers it essential to obtain members’ feedback on new initiatives and news-of-the-day. To address this need, the Society has launched SCAI Vital Signs, a new strategy for increasing response rates on quick-turnaround surveys. SCAI’s Vital Signs panel consists of member and nonmember Interventional Cardiologists who volunteer to provide quick online feedback to surveys focused on various cardiovascular issues. SCAI promises that Vital Signs participants will be surveyed no more than four times a year. By enrolling in Vital Signs, you agree to respond within 24 hours of receiving an emailed invitation with a link to an online questionnaire. Respondents will also receive a summary of results from each survey in which they participate. The Society’s goal is to grow the Vital Signs panel large enough that samples will be drawn scientifically so as to represent the Society’s full membership or, if more appropriate, samples of subspecialists may be used. Samples may also serve as control groups in the measurement of performance outcomes and impacts resulting from SCAI’s educational programs. The Society is exploring whether participation in Vital Signs can be used for Maintenance of Certification purposes. Interventionalists interested in serving on the panel or wanting further information should email Sandra Baxter at sbaxter@scai.org for registration details.
An overwhelming majority of survey respondents – 91 percent – also said that patient care would worsen if the Food and Drug Administration limited interventional devices to on-label usage. Because of safety concerns, the FDA over the last few years has considered imposing restrictions on the off-label use of drug-eluting stents in patients whose cases were more complex than those studied when the devices were approved. DES use is off-label in at least 60 percent of patients, according to the agency. A large-scale study released this March by Duke University researchers evaluating outcomes from the NCDR and CMS databases found that drug-eluting stents are safe and more effective than bare metal stents in real-world use. “If drug-eluting stents were only allowed for on-label utilization, patients would certainly suffer, because they’ve had tremendous benefit across the board. That is not to say we do not need longer-term data and more information in complex lesion subsets, or that off-label use should not be performed without caution,” Dr. Turco said. For more information on SCAI’s position on comparative effectiveness, or its activities in health care reform, visit www.SCAI.org n
CALL TO ACTION
A Voice of Its Own: SCAI Seeks Official AMA Membership Membership in the American Medical Association (AMA) is a great opportunity to “speak specifically for the interests of invasive interventional cardiology at a national forum,” says Joseph D. Babb, M.D., FSCAI, professor of medicine at the East Carolina University Brody School of Medicine in Greenville, NC, and Chair of SCAI’s Advocacy Committee. But it is an opportunity SCAI will miss unless at least 25 percent of its U.S. members join the AMA by the summer of 2011. Dr. Babb explains, “We have to show the AMA, that our membership is committed to the broad mission of the AMA.”
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Advocacy & Guidelines As an official member of the AMA, SCAI would gain at least one vote in the AMA House of Delegates (HOD), the principal policymaking body of AMA, and be in a better position to help shape medical policy by gaining access and participating in AMA Council meetings as well as having the new opportunity to sit on the AMA’s Board of Governance and the AMA Physician Consortium for Performance Improvement Board of Governance. SCAI would gain the ability to have its vote count on proposed quality measures in the Physician Consortium for Performance Improvement and be afforded the opportunity to appoint official SCAI physician advisors to the advisory bodies for the AMA/Specialty Society Relative Value Scale Update Committee (RUC) and the CPT Editorial Panel, both of which are driving forces regarding reimbursement issues.
One Step Closer SCAI completed the first step toward official AMA membership in June 2008 by becoming a member of the AMA’s Subspecialty and Service Society (SSS). The SSS, a body of more than 130 national medical societies, military service groups, and medical associations, is the largest caucus in the AMA’s HOD. Its members debate a broad range of issues, including public health, clinical medicine, health care policy, and reimbursement that ultimately may come before the HOD for consideration and vote. After three years as an active member of the SSS, the Society may apply for admission to the HOD. Until then, SCAI must show its commitment to AMA by attending its twice-yearly meetings and working to increase AMA memberships among SCAI members. Another Voice In the past, SCAI was represented at the AMA by the American College of Cardiology (ACC) as a member of its Section Council on Cardiovascular Diseases. SCAI and other subspecialty societies advise the ACC in its capacity as a voting member of the AMA. “As a full-fledged member of the AMA,” says Dr. Babb, “SCAI will continue to work with the ACC and other cardiovascular physician societies as another avenue to represent their points of view at the table. “This is not an attempt to go in a different direction from the ACC,” Dr. Babb continues. “The ACC has represented all of cardiology quite capably.”
It’s simply time for SCAI to have a voice of its own, Dr. Babb explains. “Rather than speaking through someone else, SCAI will add its own voice to make its message and the message of all cardiologists a little louder and a little clearer.” To join the AMA, visit https://membership. ama-assn.org n
Interventionalists Must Act to Reduce Workplace Risks, Report Recommends
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ccupational health risks have assumed epidemic proportions for physicians working in interventional medicine, according to a consensus statement published by SCAI and several other professional medical societies whose members work in cardiac catheterization laboratories. Surveys of cardiologists and radiologists conclude that there is evidence of a relationship between wearing lead aprons and spinal problems. A 2004 SCAI survey found that nearly half of the 424 respondents reported spine problems, dramatically higher than the 27.4 percent incidence of chronic back conditions in adults in the United States. More than one-third of the respondents said their spine problems had caused them to miss work. One-fourth of the respondents reported problems related to their hips, knees, or ankles. The survey also found a significant relationship between the number of years worked in the cardiac catheterization laboratory and the incidence of spine problems. Striking a comparison with An Inconvenient Truth, a 2006 documentary film about global warming, the authors of the consensus statement urge interventionalists to change their behavior in light of overwhelming evidence of occupational health risks. “Complacency can be dangerous,” they write. “Daily exposure to radiation, orthopedically burdensome personal protective apparel that is only partly protective and poor ergonomic design of fluoroscopic equipment and procedure rooms constitute the ‘inconvenient truth’ of our profession.
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Surveys Have Found •
Nearly half of respondents reported spine problems
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More than one-third said spine problems caused them to miss work
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One-fourth reported problems with hips, knees, or ankles
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A significant relationship between years in the cath lab and incidence of spine problems
“Now is the time for physicians and their professional societies to work together and with industry to make our working environment better,” the authors urge. Important steps toward that goal include achieving a zero radiation–exposure work environment, which ultimately would eliminate the need for personal protective apparel and prevent its orthopedic and ergonomic consequences. Writing group member James Goldstein, M.D., FSCAI, who, along with L l o y d W. K l e i n , M . D . , FSCAI, first encouraged the Society to take a leadership role in this vital area, said, “I know of no other industry James Goldstein, M.D., that would subject its workers FSCAI to such hazards. If workers in automobile factories, for example, faced such occupational risks, I can’t imagine the unions, courts, or the Occupational Safety and Health Administration standing by.” The need to quantify the risk presented by occupational health concerns led to the formation of the Multi-Specialty Occupational Health Group (MSOHG), whose member organizations include SCAI, Society of Interventional Radiology, Heart Rhythm Society, American College of Radiology, American College of Cardiology, Society of NeuroInterventional Surgery, American
Association of Physicists in Medicine, and Society of Invasive Cardiac Professionals. The MSOHG will work in collaboration with the U.S. Navy and the Radiation Epidemiology Branch of the National Cancer Institute to perform epidemiological studies addressing the incidence of orthopedic and radiationassociated problems; radiation-induced diseases meriting concern in addition to cancer and cataracts; mechanisms contributing to orthopedic problems, such as heavy personal protective apparel, working positions, and nonergonomic equipment designs; and individual operator factors associated with development of orthopedic and radiation-associated problems, including number of cases per year over a career, laboratory shielding, and laboratory design. In the meantime, the expert consensus document’s lead author, Dr. Klein, is urging interventionists to be more aware of the risks their workplace presents and the need to manage those risks. He points to Lloyd W. Klein, M.D., the epidemic of orthopedic FSCAI injuries experienced by interventionalists, noting deep economic and personal consequences. The high prevalence of orthopedic problems, in particular those spinerelated, often result in missed days of work, surgery, and, in some cases, curtailed careers. While radiation exposure for health care workers has declined as awareness and technological advances have improved, busy interventionists not uncommonly approach or exceed the limits previously believed to be acceptable, he said. “When we chose an invasive career, we accepted these risks as ‘the cost of doing business.’ Day to day, most of us try to ignore what we cannot see, even to the extent of not wearing the required radiation badges, afraid to know the truth, or even worse to be pulled out of the laboratory as a result of ‘excess’ monthly exposures.” The consensus statement was published in Catheterization and Cardiovascular Interventions and is available at www.SCAI.org. For more information on SCAI’s efforts to reduce workplace hazards for interventionalists, write to info@scai.org. n
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Cabo San Lucas Cabo Interventional Summit: A Second Year of Success Attendees and faculty agree that SCAI’s 2nd Annual Cabo Interventional Summit held March 16–20, 2009, in Cabo San Lucas, Mexico, was an all-around success. The program, directed by Robert M. Bersin, M.D., FSCAI, Director of Endovascular Services and Clinical Research at Seattle Cardiology and The Cardiovascular Consultants of Washington, and Efrain Gaxiola, M.D., Immediate Past President of the Sociedad de Cardiología Intervencionista de México (the Interventional Cardiology Society of Mexico), from Guadalajara, Mexico, was created to provide practicing interventionalists with a complete update and to strengthen ties with the Latin American Interventional Cardiology community. “This is a high-level meeting intended for high-level interventionalists,” says Dr. Bersin. “It’s soup to nuts in an international setting that truly gives us a broader perspective on how to manage patients.”
Educational Highlights Thirty-two of the world’s leading interventional faculty, including renowned Latin American interventionalists, lectured, presented cases, and participated in panel discussions. The program covered everything from cholesterol management to coronary interventions, endovascular therapies, and structural heart disease developments. The inclusion of such diverse topics as billing and coding for endovascular procedures, the latest on lipids, intravascular ultrasound and plaque, and CT angiography made for a truly comprehensive educational experience. Each day, a series of structured didactic lectures with an emphasis on interactive case sessions was followed by something new this year—an in-depth symposium on some of the topics covered earlier in the day. “This was a highly successfully change to the program,” says Dr. Bersin. “It gives people a chance to interact, ask questions, and discuss particular topics in detail.” This year’s symposia were on endovascular devices, complex coronary techniques, imaging, and structural heart disease. Great Location The relaxed setting and afternoon breaks give attendees an opportunity to interact with faculty in a way that just isn’t possible at other meetings. He says, “People are raving about that aspect.” Besides the beautiful March weather with temperatures in the mid-70s, Cabo San Lucas is a safe and affordable location on Mexico’s Baja California Peninsula. “This is an appealing, hospitable community and yet at the same time, air fare and hotel rates are reasonable and comparable to other meetings,” says Dr. Bersin. The faculty, content, location, and Latin American involvement is a great formula, says Dr. Bersin. “You just can’t beat it.” n
Dr. Robert Bersin (shown here) and Dr. Efrain Gaxiola directed the 2nd Annual Cabo Interventional Summit.
Dr. Jeffrey J. Popma moderated cases on advances in structural heart disease. He also updated attendees on progress in self-expanding percutaneous valves for the treatment of aortic valve disease and discussed optimal pharmacology for primary PCI.
Dr. Eberhard Grube discussed techniques, strategies, and new devices for the percutaneous treatment of left main disease.
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SCAI Consensus Statement (cont’d from pg 2)
Acknowledgments SCAI gratefully acknowledges and thanks the following companies for their generous educational grants and exhibits. Their ongoing commitment to physician education is greatly appreciated.
Gold Supporters • Abbott Vascular • Boston Scientific
Bronze Supporters • Daiichi Sankyo, Inc. and Eli Lilly and Company • Medtronic Vascular • The Medicines Company • W.L. Gore Associates
Exhibitors • Boston Scientific • Cook Medical • Genentech, Inc. • Medrad Interventional/Possis •P athway Medical Technologies Inc. • Spectranetics • Vascular Solutions, Inc.
Mark Your
Calendar!
3rd Annual Cabo
Interventional Summit
March 29-April 2, 2010 Watch SCAI.org for updates
It concludes that patients can be sent home within 12 hours of an uncomplicated procedure if they have stable angina with no elevated biomarkers; have no significant co-morbidities; are asymptomatic with an abnormal stress test; have normal renal function and a normal left ventricular ejection fraction; and have access to emergency medical care and support at home. “Each patient situation is unique and we have to consider all the variables when determining followup care, including whether a patient has someone at home to help him or her,” said Dr. Dehmer, who is an SCAI past president, and professor of medicine at Texas A&M University College of Medicine and director of Gregory J. Dehmer, the Cardiology Division at Scott & M.D., FSCAI White Healthcare in Temple, TX. Patients who require short-term observation include those who experienced minor complications during the procedure; have an unstable access site; were transferred from another facility for the procedure; received long stents or multiple stents in the same vessel; have a history of congestive heart failure; or have symptoms of myocardial ischemia. Patients need to be held for extended observation if they had complications during the procedure; received a large volume of contrast medium; have significant cardiac conditions like cardiac rhythm disorders; have decompensated chronic obstructive pulmonary disease requiring increased medication; have a left ventricular ejection fraction of less than 30 percent; or have decompensated congestive heart failure with increased medication requirements. The paper recommends inpatient admission for patients who experienced significant complications during the procedure, require additional revascularization, or have significant co-morbidities. “Decisions about when to discharge a patient should never be solely about cost or reimbursement, but about exercising the best-informed medical judgment for each patient,” said SCAI President Steven R. Bailey, M.D., chair of the Division of Cardiology, professor of medicine and radiology, and Janey Briscoe Dis- Steven R. Bailey, M.D., tinguished Chair at the University of FSCAI Texas Health Sciences Center at San Antonio. The consensus statement has been endorsed by the American College of Cardiology Foundation and is available at http://www.scai.org/ pdf/20090507StatementPCICCI.pdf. n