www.scai.org
www.seconds-count.org
July/August 2010
IN THIS ISSUE:
SCAI 2010 Highlights See pages 6–13
The Society for Cardiovascular Angiography and Interventions
SCAI Receives Wenger Award for Commitment to Women’s Heart Health
Cardiac Rehab Has Much to Offer Post-PCI Patients
he Society for Cardiovascular Angiography and Interventions was recently awarded a Wenger Award for excellence in health care in recognition of its dedication to raising awareness about disparities in heart health care. Each year, WomenHeart: The National Coalition for Women with Heart Disease honors individuals and organizations for their commitment to improving the lives of women with heart disease. SCAI, the first medical society to receive a Wenger Award, was recognized this year for its increasing involvement in addressing disparities in women’s heart health, including the establishment of Women in Innovations (WIN), an initiative chaired by SCAI members.
f cardiac rehabilitation were a pill, people with heart disease would be downing it with their orange juice every morning, and for good reason. Its benefits include improved survival, better exercise tolerance, and a reduction in blood pressure and blood lipid levels, to name just a few. But instead of being a staple of secondary prevention, cardiac rehabilitation is woefully underutilized in most communities. Proponents want to change that by reminding both physicians and patients that cardiac rehabilitation ranks right up there with statins, aspirin, beta blockers, and other guideline-recommended therapies in getting patients back on a healthy footing.
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SCAI Advocates for Patient Access to Specialty Care Watch for more news in the next issue of SCAI News & Highlights
Senator John McCain (R-AZ) was among numerous elected representatives and their staff who met with SCAI leaders during the recent Alliance of Specialty Medicine event on Capitol Hill. From left: President-Elect Dr. Christopher J. White, Senator John McCain, President Dr. Larry S. Dean, and Past President Dr. Joseph Babb joined approximately 50 other specialists for two days of visits with members of Congress. Among the topics addressed: the new healthcare reform law, ensuring patients’ access to specialists, and how to replace the SGR-based Medicare physician payment system. Watch the next issue of SCAI News & Highlights for more details about their experience on Capitol Hill, next steps, and how you can help!
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New Accrediting Body to Improve Patient Care and Help Interventionalists Demonstrate Quality
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n May, SCAI announced the formation of Accreditation for Cardiovascular Excellence (ACE), an independent nonprofit organization that will help providers of invasive, interventional, and endovascular procedures deliver safe, effective, and high-quality patient care, says Bonnie Weiner, M.D., MSEC, MBA, FSCAI, SCAI past president and president of ACE. “Our primary goal for ACE is to increase the consistency of superior patient care in cardiovascular and endovascular procedures throughout the United States,” says Dr. Weiner. “When patients are treated at a facility that is ACE-accredited, they should feel confident that the appropriate, evidenceBonnie Weiner, M.D., based steps have been taken to help ensure MSEC, MBA, FSCAI the best care for each individual patient.” ACE will draw on the scientific literature to set standards for quality care, establish requirements for accreditation, and provide peer review of facilities providing invasive cardiac and endovascular procedures. ACE will also make available tools and guidance to help facilities that are seeking accreditation or that have achieved provisional, rather than full, accreditation. “An important goal is to promote self-evaluation and give providers the tools for ongoing quality improvement,” stresses Dr. Weiner. Kenneth Rosenfield, M.D., FSCAI, and Christopher White, M.D., FSCAI, are ACE’s co-directors.
Getting Accredited ACE has begun its work by focusing on carotid artery stenting programs but will eventually branch out to facilities performing other procedures. At this point, ACE accreditation is voluntary; however, Dr. Weiner predicts that facilities will want to apply for accreditation as a way of demonstrating their commitment to the best possible patient care. ACE accreditation, she says, “sets a standard by their peers of what quality is in invasive and interventional labs.” Accreditation will bring benefits to practices as well as patients. “We hope to work with some of the payers even beyond the Centers for Medicare and Medicaid Services (CMS) to be able to use accreditation as a mechanism for reducing the administrative load on facilities from a reporting standpoint,” says Dr. Weiner. “If the payers accept ACE accreditation as valid oversight, then it would streamline the process for their facility and meet payers’ requirements in order for them to be reimbursed.” Facilities applying for ACE accreditation must submit data and participate in a site visit, with the goal of assessing whether their processes and procedure outcomes meet pre-determined benchmarks. These benchmarks are
based on scientific evidence in the peer-reviewed medical literature and professionally determined quality metrics. The accreditation process will also include validation of self-reported data and appropriate use of existing guidelines and knowledge of changing best practices. For most sites, a nurse will conduct the site visit, with oversight by a physician team. Sites with high complication rates or other red flags will undergo a review by a physician team, which will investigate what’s causing the variation in processes or outcomes as a peer-to-peer mechanism for assistance in improvement. “The goal is not to be punitive,” Dr. Weiner emphasizes. “To the contrary, the goal of ACE is to provide facilities with tools they can use to improve what they’re doing.” If a facility isn’t meeting the criteria for appropriate use of carotid stenting, for example, ACE would offer documents and concrete suggestions for bringing their usage into line with accepted protocols.
(continued on page 4) 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 Larry S. Dean, M.D., FSCAI, President Christopher J. White, M.D., FSCAI, President-Elect Steven R. Bailey, M.D., FSCAI, Immediate Past President J. Jeffrey Marshall, M.D., FSCAI, Vice President Carl L. Tommaso, M.D., FSCAI, Treasurer Theodore Bass, M.D., FSCAI, Secretary Morton Kern, M.D., FSCAI, Editor-in-Chief _______________________________________________________________ Trustees Alexander Abizaid, M.D., FSCAI Lee N. Benson, M.D., FSCAI Jeffrey Cavendish, M.D., FSCAI Tyrone J. Collins, M.D., FSCAI Anthony Farah, M.D., FSCAI Runlin Gao, M.D., FSCAI James A. Goldstein, M.D., FSCAI James Hermiller, M.D, FSCAI Thomas Jones, M.D., FSCAI Upendra Kaul, M.D., FSCAI Clifford Kavinsky, M.D., Ph.D., FSCAI Ahmed Magdy, M.D., FSCAI Roxana Mehran, M.D., FSCAI Issam D. Moussa, M.D., FSCAI Kimberly A. Skelding, M.D., FSCAI Corrado Tamburino, M.D., FSCAI Zoltan G. Turi, M.D., FSCAI
Staff Norm Linsky Executive Director Kerry O’Boyle Curtis Senior Director for Education, Meetings, & Communications Wayne Powell Senior Director for Advocacy & Guidelines Kathy Boyd David Communications Director Mary Hogan Membership Manager Terie King CPA, Director of Finance & Accounting Bea Reyes Director of Operations
Trustees for Life Frank J. Hildner, M.D., FSCAI William C. Sheldon, M.D., FSCAI
touch three Design and Production Imaging Zone Printing
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Cardiac Rehab (cont’d from pg 1) “First and foremost, cardiac rehab saves lives—and the magnitude of the benefit is at least equal to that of any medication,” said Richard A. Josephson, MS, M.D., a professor of medicine at Case Western Reserve University School of Medicine and director of cardiovascular and pulmonary rehabilitation at University Richard A. Josephson, Hospitals Health System in Cleveland. MS, M.D. “Cardiac rehab also improves quality of life, favorably modifies many proven cardiovascular risk factors, and educates patients about diet, exercise, and how to manage stress, depression, and anxiety—things interventional cardiologists would want their patients to know.” The Centers for Medicare and Medicaid Services (CMS) is convinced. Since Jan. 1, cardiac rehabilitation services have been explicitly covered nationwide under Medicare Part B for patients with established coronary artery disease, including those who have undergone percutaneous coronary interventions (PCI). This ruling strengthens a 2006 provision that, for the first time, included PCI as a covered indication for cardiac rehab billed as incident to physician services. So why aren’t more cardiac patients donning sweat pants and walking shoes, and learning how to live longer, healthier lives? Nationwide, only about 15 percent of eligible patients participate in cardiac rehab, on average. And it seems that patients who have undergone PCI may be even less likely to sign up than those who have had a myocardial infarction (MI) or undergone bypass surgery. “It’s a major problem with PCI,” said Adam deJong, MA, an exercise physiologist and assistant director of preventive cardiology and rehabilitation at William Beaumont Hospital in Royal Oak, MI. “Angioplasty seems like an easy fix. There’s less trauma than with coronary bypass surgery. Patients think they’re fixed, Adam deJong, MA and they want to get on with their lives.” But a low rate of physician referral is often a problem as well. SCAI is partnering with the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) on a number of activities to raise awareness of the benefits of cardiac rehabilitation. For starters, SCAI has added new content on the benefits of cardiac rehab to Seconds-Count.org, the Society’s website for patients and the public. And SCAI has enthusiastically welcomed AACVPR as one of several partners hosting the next Know What Counts regional education program and public forum. The event, slated for September 2010 in Atlanta, will bring together the provider and patient community, as well as media and policymakers, for frank discussion about the challenges related to adhering to prescribed medical
therapies and lifestyle changes after PCI and other therapies. The value of cardiac rehabilitation along the continuum of care will be an important message delivered during the Know What Counts program. “One of the most important things we can do as healthcare providers is make sure that patients are getting appropriate therapies to maximize their health and clinical outcomes,” said Randal J. Thomas, M.D., MS, AACVPR president and director of the cardiovascular health clinic at the Mayo Clinic, Rochester, Randal J. Thomas, MN. “Cardiac rehabilitation is a vastly M.D., MS underutilized life-saving therapy for patients with cardiovascular disease. We see partnership with SCAI not only as helping our patients, but also helping our interventional colleagues with the outcomes they desire for their patients.” Research presented at the 2010 annual meeting of the American College of Cardiology by Dr. Thomas’s Mayo Clinic team shows just how beneficial cardiac rehab can be for post-PCI patients. The community-based study recruited nearly 1,000 patients who participated in cardiac rehab after PCI, following them for an average of just over six years. All-cause mortality was about 45 percent lower among cardiac rehab participants than in a matched control group that did not participate in an exercise and education program. Cardiovascular mortality and a composite of death, MI, and revascularization were also significantly reduced by participation in cardiac rehab. Published studies of patients referred to cardiac rehab after an MI, PCI, or bypass surgery are also persuasive. For example, an analysis of 601,099 Medicare beneficiaries by Suaya and colleagues, published in the June 30, 2009, issue of the Journal of the American College of Cardiology found that just 12 percent of eligible patients participated in cardiac rehabilitation. However, among participants, five-year mortality was reduced by 21 percent to 34 percent when compared to nonparticipants. Cardiac rehab has also been shown to reduce such symptoms as angina, shortness of breath, fatigue, depression and anxiety, and to improve exercise performance, quality of life, and the ability to perform day-to-day tasks. Rates of hospitalization are also lower among patients who participate in cardiac rehab. Some of the reasons may be obvious: Program participants are in better shape than those who spend their days in a La-Z-Boy recliner. But other reasons may be more subtle. Research from the Mayo Clinic has shown that patients who attend cardiac rehab programs are 30 percent to 40 percent more likely to stay on prescribed medications. And Dr. Josephson has observed that simply being able to ask questions and discuss concerns with a medical professional on
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Cardiac Rehab (cont’d from pg 3) a regular basis can keep a patient’s worries from getting out of hand. “Many patients develop somatic symptoms and concerns, which can lead to emergency room visits, many of which are unnecessary,” he said. “Cardiac rehabilitation can cut down on these.” Features to look for in a stand-out cardiac rehab program, according to Mr. deJong, include AACVPR certification, a strong educational emphasis, and an educated and well-rounded staff that includes nurses, exercise physiologists, dietitians, and experts in psycho-social issues and behavioral health. In addition, the exercise program should consist not only of cardio training but also resistance training, which helps patients feel better faster and has a greater effect on the ability to perform daily tasks. Some programs also have extended hours, so that patients can continue to participate after returning to work. Others aim to improve participation among women by offering women-only exercise times and support groups. Studies have
shown that although women are significantly less likely than men to be referred for cardiac rehab and even less inclined to enroll in a program, those who do participate benefit at least as much as men. Cardiac rehab specialists believe simple steps could improve referral among all patients, including women. First of all, they’d like to see referral to cardiac rehabilitation listed with a check-off box on standing discharge orders in cardiac catheterization laboratories, just as routine post-PCI medications are. Getting patients to actually enroll and participate in a cardiac rehab program is a separate challenge. With a few well-chosen words, interventional cardiologists can play an important role in overcoming that hurdle. “The mere act of a physician telling a patient, ‘I believe cardiac rehab is important’— that simple 20-second intervention has a substantial impact,” Dr. Josephson said. Healthcare providers and patients can access AACVPR’s Find a Cardiac Rehab Program tool via http://www.scai.org/SecondsCount/ Treatment/cardiacrehab.aspx. n
Accrediting Body (cont’d from pg 2) Dr. Weiner is hopeful that CMS will soon approve ACE as an official accrediting body. “We’re cautiously optimistic that CMS will open the coverage decision for carotid stenting some time this fall, at which point we can apply to them to be an accrediting body,” she says. ACE accreditation will last for a two-year period, after which a review of the facility will be required for continued ACE recognition.
Focusing on Quality Improvement SCAI began discussing the prospects for a new accrediting agency five years ago when CMS started requiring accreditation for carotid stenting, explains Dr. Weiner. “CMS became the default organization, because there was nothing else out there,” she says. “We hope to replace that system with our own, which we think is more robust. If CMS agrees, our accreditation would serve as the CMS accreditation.” Following carotid stenting accreditation, ACE will open its processes to facilities performing procedures such as coronary interventions and endovascular procedures as well as structural heart disease interventions. While there’s currently no mandate to accredit anything other than facilities performing carotid stenting,
Dr. Weiner and others believe such mandates are on the horizon—especially in the current era of healthcare reform. One likely candidate for an accreditation mandate is percutaneous valve therapy, says Dr. Weiner. “There’s a lot of interest in some kind of independent oversight of cath and endovascular labs doing invasive procedures,” she says. The ACE initiative is of the utmost importance to the specialty of invasive/interventional cardiology, says Dr. Rosenfield. “ACE will help us to advance quality standards and set a standard of care not just for our field but for all of medicine,” he explains. “Equally important is that, with ACE, we are demonstrating to our peers in other specialties, our patients, policymakers, and the public that Kenneth Rosenfield, we take responsibility for monitoring M.D., FSCAI ourselves and for ensuring high-quality care is delivered in all cath labs.” SCAI is in discussions with potential ACE partner organizations. For more information or to apply for accreditation, visit www.cvexcel.org or contact Executive Director Mary E. Heisler, R.N., at mheisler@cvexcel.org. n
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Wenger Award (cont’d from pg 1) Since its creation earlier this year, members of WIN have published a consensus paper recommending strategies for improving the outcomes of female patients, and SCAI partnered with WomenHeart to survey more than 300 members of WomenHeart to gather more information about women and heart disease. Together, SCAI and WomenHeart also launched WINHeart - Score a WIN for Women, a campaign to raise awareness surrounding gender-based disparities in the diagnosis, treatment, and survival of women with heart disease.
Raising Patient and Physician Awareness “As a physician and a woman, it’s alarming so many women are not aware heart disease is their number one killer in America,” explains SCAI Past President Bonnie Weiner, MD, MSEC, MBA, FSCAI, director of interventional cardiology research at Saint Vincent Hospital at Worcester Medical Center in Massachusetts and co-chair of WIN. “Women tend to be less aware of symptoms and subsequently see their doctor much later than they should, which unfortunately results in poorer outcomes and fewer treatment options.” The problem is global and one that WIN is addressing with healthcare providers as well, says Alaide Chieffo, M.D., FSCAI, director of research at San Raffaele Hospital, scientific coordinator of the Master in Interventional Cardiology at Vitae-Salute San Raffaele University in Milan, and co-chair Alaide Chieffo, of WIN. “Raising awareness of both M.D., FSCAI patients and healthcare providers will go a long way toward optimizing the diagnosis and treatment of female patients with cardiovascular disease.” Working Toward Solutions “Our goal,” says WIN co-chair and senior author of the WIN consensus paper Roxana Mehran, M.D., FSCAI, “is to break down the barriers created by mixed messages and myths, so that women and members of the healthcare community are less likely to underestimate the extent of the problem.” Dr. Mehran is director of outcomes research at the Center of Interventional Vascular Therapies and associate professor of medicine at Columbia University Medical Center in New York City. The Wenger Award is also an acknowledgment of the Society’s Know What Counts regional education program and briefing held last March on Capitol Hill. This educational program at the U.S. House of Representatives drew a diverse audience of community members, including House staffers, primary care physicians, patients, and other members of the public.
WomenHeart recognized the Society’s dedication to raising awareness about disparities with a Wenger Award for excellence in health care. The Wenger award honors individuals and organizations for their commitment to improving the lives of women with heart disease. From left: Dr. Larry Dean, Dr. Roxana Mehran, WomenHeart CEO Lisa Tate, SCAI Associate Director of Education Rebecca Ortega, Dr. Bonnie Weiner, and Dr. Mark Turco.
Program Director, Mark Turco, M.D., FSCAI, director of the Center for Cardiac and Vascular Research at Washington Adventist Hospital in Takoma Park, MD, working in partnership with the Association of Black Cardiologists, Inc., (ABC), Mended Hearts, and WomenHeart brought together an esteemed faculty that examined the racial, ethnic, and gender disparities in health care and discussed, with input from the audience, how to address these issues in the coming century.
SCAI’s Continuing Commitment “We are thrilled that WomenHeart recognizes these and other contributions SCAI is making in the diagnosis and treatment of women with heart disease,” says SCAI President Larry S. Dean, M.D., FSCAI, director of the UW Medicine Regional Heart Center in Seattle. “The award is a great honor and a testament to our physicians who are working every day to close the disparity gap in heart health disparities, whether that gap be gender, race, or economic-based.” SCAI was recognized with other 2010 Wenger Award recipients Nanette Kass Wenger, M.D., for Distinguished Leadership; Katherine Uhl, M.D., for Public Service; and sanofi-aventis for Corporate Leadership. For more information on how you can get involved in WIN, email Rebecca Ortega at rortega@scai.org. For more information about SCAI’s Know What Counts programs, contact Kathy Boyd David at kbdavid@scai.org. n
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SCAI 2010 SCAI’s Annual Scientific Sessions Achieves Excellent and Diverse Attendance
Dr. John W. Moore gave the Mullins Lecture, highlighting progress made in the treatment of congenital heart disease, and where the specialty is headed.
Drs. Mort Kern and Barry Uretsky
“A great success!” That’s how program co-chair James B. Hermiller, M.D., FSCAI, describes SCAI’s 33rd Annual Scientific Sessions, held May 5–8 in San Diego. The event brought together more than 1,300 interventional cardiologists and other physicians at all stages of their careers, cath lab nurses, technicians, and industry representatives. “Attendance was exceptionally good and up from last year,” said Dr. Hermiller. “That’s especially impressive, given the economy and the other challenges we’re facing in health care.”
Impressive Faculty, Excellent Content One of the factors that helped attract so many participants was the impressive faculty, said Christopher J. White, M.D., FSCAI, who co-chaired the meeting with Dr. Hermiller. “When you look at the list of faculty members, you see that the real stars of interventional cardiology were there,” he says. One such star was Geoffrey Hartzler, M.D., who described the early days of angioplasty in his Founders’ Lecture. A pioneer in interventional cardiology, Dr. Hartzler performed the first coronary angioplasty at the Mayo Clinic in 1979, just two years after the procedure debuted in Switzerland. “He’s one of the giants in our field,” said Dr. White, noting that the lecture was standing-room-only. “People
walked out of his talk feeling good about themselves and what they do.” Another highlight was the Hildner Lecture given by Robert Califf, M.D., who offered an overview of the hotly debated topic of comparative effectiveness. “Dr. Califf’s talk was particularly timely, given the debate about healthcare reform,” said Dr. White. “The new law will only intensify the focus on quality, cost and comparative effectiveness of different treatment options, so everyone in health care will be affected. The annual meeting was an excellent venue for talking about changes we’ll all be experiencing soon.” Attendees also raved about the live cases, said Dr. White. Thanks to satellite technology, meeting participants were able to watch as interventional cardiologists across the country performed procedures live. “The cases were diverse, educational, and entertaining,” said Dr. White. A panel of experts moderated the sessions and encouraged participants to ask questions, comment on the cases, and even explain how they might have done things differently. The program also featured some new topic areas. Several popular sessions were devoted to radial access, for instance, including a transradial “minicourse,” simulator sessions, and a new emphasis on treatment of peripheral arterial disease. For congenital/pediatric interventionalists, there was even more of the Congenital Heart Disease Symposium to enjoy than usual. While the symposium has traditionally been a two-day event, this year it expanded to include an additional afternoon session devoted to “brain scratchers.” These were unusual cases that “make you stop in your tracks,” explained Frank F. Ing, M.D., FSCAI, who chaired the congenital heart disease program along with Daniel S. Levi, M.D., FSCAI.
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Another new and successful session for SCAI’s many congenital heart disease interventionalists was titled, “Mythbusters.” It highlighted interventional approaches “that are handed down from fellow to fellow but that may not be truly evidence-based,” said Dr. Ing. Other highlights included the perennially popular “I Blew It!” session and the Mullins Lecture, featuring John W. Moore, M.D., FSCAI, who reviewed the past, present, and future of stents in congenital heart disease. “I had a lot of positive feedback about the program,” said Dr. Ing. In fact, he said, the symposium now attracts participants beyond the realm of pediatric interventional cardiology. “I’m seeing more and more participation from adult interventionalists dealing with structural heart disease,” he said. Of course, said Dr. Hermiller, the real draw of SCAI’s annual meeting for all cardiovascular healthcare providers is its overall emphasis on practicality. “What makes this meeting so good is that it’s a distillation of the newest and best in interventional cardiology, presented in a way that attendees can take home and apply in their everyday practices,” he said.
Mark Your Calendar for SCAI 2011 This year’s location—the Hilton San Diego Bayfront— was a big hit. “There was a lot of common space where you could run into your friends and people you hadn’t seen in a long time and just talk,” explained Dr. White. Now he and Dr. Hermiller are trying to re-create that sense of intimacy and interactivity as they begin planning for next year’s Annual Scientific Sessions. The meeting will take place May 4–7 near the Inner Harbor in Baltimore, MD. The co-chairs plan to have more small groups and a more case-based approach next year. And to further encourage participation, they’re considering the use of audience-response “clickers” that allow participants to share their thoughts or vote on issues. “We want to make the meeting even more intimate and meaningful for attendees,” explained Dr. White. “Attendees may sit through a big meeting room lecture for something special, but they don’t want to spend a whole day like that. We’re going to put them in rooms with their peers, so they can talk about their day-to-day problems and issues.” To check out video highlights of the meeting, visit www. SCAI.org, and for information about next year’s Annual Scientific Sessions, visit www.scai.org/scai2011. n
SCAI Annual Meeting Showcases Clinical Research Reports
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n addition to top-notch education, SCAI’s 2010 Annual Scientific Sessions featured a wide selection of innovative clinical research reported on by journalists attending the conference as well as those following the meeting virtually. Following are selected highlights of studies that received attention: Interim data from the Zilver ® PTX TM Global Registry, presented in a late-breaking clinical trial session by William Gray, M.D., FSCAI, were among the first to show the safety and effectiveness of drugeluting stents for the treatment of peripheral arterial disease (PAD). The single-arm international study found that the Zilver® PTXTM paclitaxel-coated stent was associated with excellent stent durability and sustained clinical benefit at 12 and 24 months, even in patients with complex lesions. The study enrolled 787 patients with disease of the superficial femoral artery. Clinical history included restenosis in 24 percent, in-stent restenosis in 14 percent, total occlusion in 38 percent, and lesions longer than 15 cm in 22 percent. Mean lesion length was 10 cm, and mean percent diameter stenosis was 84.6 percent. Patients were treated with 2.2 stents, on average. At 12 months, event-free survival was 87 percent, freedom from target lesion revascularization (TLR)
was 90.5 percent, and the rate of stent fractures was 1.5 percent. Among patients available for 24-month follow-up, event-free survival was 80 percent, and freedom from TLR was 83.3 percent. Ankle-brachial index, Rutherford Classification, walking distance and walking speed were all significantly better at both 12 and 24 months, when compared to baseline. Results of a separate pivotal randomized study in a similar cohort of patients are expected to be available later this year. The ARMOUR study, presented by Robert Bersin, M.D., FSCAI, showed that use of the MO.MA proximal cerebral protection device during carotid stenting reduced the 30-day risk of myocardial infarction (MI), stroke, or death by approximately 75 percent when compared to typical results with a distal protection device. The MO.MA system consists of two balloons that are positioned proximal to the stenosis, one in the main carotid artery and one in the external carotid artery. Inflation of the balloons temporarily stops blood flow to the internal carotid artery. After stent placement, a syringe is used to suction any debris from the internal carotid artery. For the study, researchers recruited 225 patients who were considered too high-risk for carotid endarterectomy. Carotid stenting with MO.MA protection was
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SCAI honors distinguished member. Dr. Ashok Seth (left) received the Society’s highest honor, the F. Mason Sones, Jr., Distinguished Service Award, in recognition of his commitment to advancing SCAI’s mission. Dr. Seth, shown here with SCAI President Dr. Steven R. Bailey, has spearheaded the Society’s educational and membership growth in the Asia-Pacific region.
SCAI 2010
Founders’ Lecturer inspires generations of interventional cardiologists. Dr. Geoffrey Hartzler had the audience on their feet, applauding both his lecture and his trail-blazing career.
Patient advocacy and education takes off at the SCAI Exposition. Patient advocacy and support organizations WomenHeart: The National Coalition for Women with Heart Disease (shown here in red) and Mended Hearts joined many of medicine’s industry innovators as exhibitors at SCAI 2010.
Timely and important, Dr. Robert Califf’s Hildner Lecture provided perspective on where healthcare reform, and where the push for comparative effectiveness research, will take medicine as a whole and interventional cardiology in particular.
Case-based learning in real time. Sharing their expertise via satellite, Drs. Barry Rutherford (Saint Luke’s Mid America Heart Institute), John Webb (St. Paul’s Hospital), Kenneth Rosenfield (Massachusetts General Hospital), and Paul Teirstein (Scripps Memorial Clinic) demonstrated real-time clinical decision-making during live cases sessions at SCAI 2010.
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Thanks and honors to a dedicated and passionate SCAI leader. SCAI President Dr. Steven R. Bailey thanked Dr. Mark Turco (right) for his tireless work as a SCAI Trustee and on many committees, including Advocacy, PR, and Seconds-Count.org. Dr. Turco received the F. Mason Sones, Jr., Distinguished Service Award, SCAI’s highest honor.
Distilling state-of-the-art for daily practice. SCAI 2010 addressed practical questions, such as “Should we always use FFR in multivessel PCI?”, presented by Dr. William Fearon.
SCAI’s annual meeting encourages networking and offers opportunities for friends to reconnect. SCAI Trustee Dr. Jeffrey Cavendish (right), who practices in San Diego, caught up with Dr. John Schindler, of Pittsburgh, PA.
Faculty from around the globe. New SCAI Trustee Dr. Ahmed Magdy traveled from Cairo, Egypt, to participate in SCAI 2010.
Presidential gratitude. On behalf of a grateful membership and staff, Dr. Larry Dean thanked SCAI’s 2009–10 President, Dr. Steven R. Bailey (left), for a year of accomplishments and advances on behalf of Interventional Cardiology.
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SCAI 2010 Clinical Research Reports (cont’d from pg 7) successful without major adverse cardiovascular or cerebrovascular events (MACCE) in 93 percent of patients. The 30-day MACCE rate was 2.7 percent. The major stroke rate was less than 1 percent. Saibal Kar, M.D., FSCAI, presented data from the Endovascular Valve Edge-to-Edge REpair STudy (EVEREST II) Registry showing that, in high-risk patients with grade 3 or 4 mitral regurgitation (MR), use of the MitraClip valve repair system is safe and, in the majority of patients, effective in relieving symptoms and improving functional class. The study involved 78 patients, 90 percent of whom were in New York Heart Association (NYHA) class III or IV at baseline. The procedural success rate was 96 percent, with no deaths. The 30-day mortality was 7.7 percent, significantly lower than the predicted 18.2 percent surgical mortality (p=0.008) and not significantly different from the 8.3 percent mortality in a matched medication-only control group. At 30 days, 75 percent of survivors were in NYHA class I or II. At one year, survival was 75 percent, as compared with 55 percent in the control group; 74 percent of survivors treated with the MitraClip were still in NYHA class I or II. None of the patients in the study developed more severe symptoms or worse mitral regurgitation or underwent surgery within that period. Preliminary data presented by C. Michael Gibson, M.D., FSCAI, demonstrated that the AngelMed ischemia monitor could successfully warn patients of an MI or acute coronary syndrome. The implanted device connects to a conventional pacemaker lead, and through continuous monitoring assesses a patient’s ST-segment data and compares it with reference data from the prior 24 hours. When patient-specific ischemia detection thresholds are exceeded, the implanted device buzzes inside the patient’s chest and an external pager sounds an alert. The new study involved 37 patients
Dr. William Gray
who were at high risk for an MI and were followed-up for an average of 1.5 years after device implantation. The monitor accurately detected early signs of an MI in four patients and acute coronary syndrome in another four. There were three false-positive alerts. No MIs went undetected, and no patients died during follow-up or developed Q-waves. On average, patients arrived at the emergency room 19.5 minutes after an alarm sounded. A study conducted at Aurora St. Luke’s Medical Center in Milwaukee and presented by Fuad Jan, M.D., showed that round-the-clock staffing of the cardiac catheterization laboratory—including an on-site interventional cardiologist—markedly reduced average door-to-balloon time. Researchers analyzed data from 611 consecutive patients who came directly to the emergency room with an ST-elevation myocardial infarction (STEMI) and underwent primary PCI. Of these, 41 percent arrived during offhours. Before the 24 x 7 program was launched, the median door-to-balloon time was about 99 minutes. After the program was in place, it fell to 55 minutes. Equally important, there was no difference in door-toballoon times during regular and non-business hours. Ian Gilchrist, M.D., FSCAI, of the Heart and Vascular Institute at Hershey Medical Center in Hershey, PA, presented a study showing that when PCI is performed using radial artery access, a low rate of complications enables many patients to go home the same day. For the study, researchers analyzed data from 100 patients who had a total of 106 uncomplicated PCI procedures using radial access, focusing on clinical and procedural characteristics that traditionally would have excluded patients from having an outpatient procedure. For example, the average age of patients was 62, although 26 were older than 70 years. Five patients had insulindependent diabetes, one had reduced kidney function, eight had chronic respiratory problems, four had contrast allergies, four had multivessel disease, and six had either peripheral arterial disease, congestive heart failure,
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or a prior heart transplant. Sixty-two patients lived more than 20 miles from the hospital (average, 54 miles). In addition, 23 patients underwent complex PCI. Altogether, only 15 percent of patients fit traditional criteria for same-day discharge after PCI. However, no patients were readmitted to the hospital or experienced any complications after outpatient PCI. A separate study, presented by Cardiology Fellow Zainal Hussain, M.D., and Program Director Michael Lim, M.D., FSCAI, found that when launching a program to train cardiologists in radial access, the cardiac catheterization laboratory is likely to face logistical challenges for a substantial period of time. The study
focused on the first 53 patients to undergo radial PCI at St. Louis University Medical Center, comparing them with a matched group who had earlier undergone PCI using femoral artery access. Transradial access was successful in 87 percent of patients. It took an average of 7.57 minutes to establish access using the radial artery, as compared to 4.17 minutes with the femoral artery (p=.002). PCI itself was successful in 83 percent of patients with radial artery access, vs. 96 percent of patients in the femoral access group (p=0.15). Fluoroscopy time was 10.01 minutes on average in the radial access group, as compared with 4.07 minutes the femoral access group (p=.003). n
Two Interventionalists-in-Training Receive SCAI/Cordis Research Grants at Annual Meeting
D
uring SCAI’s 2010 Annual Scientific Session, the Society and the CORDIS® CARDIAC & VASCULAR INSTITUTES awarded $25,000 research grants to two interventional fellows-in-training: Yoav Dori, Ph.D., of the Children’s Hospital of Philadelphia, and Zachary Gertz, M.D., BME, of the Hospital of the University of Pennsylvania. The SCAI/Cordis Fellowship Program for Interventional Cardiology selects two Cordis representative Marcia Schallehn congratulated Drs. Dori (left photo) and Gertz (right photo), the 2010 SCAI/Cordis research proposals each year Research grant recipients. based on their potential to explore promising advances in cardiovascular invasive/ Dr. Kussmaul noted the important support SCAI has interventional techniques that will have a positive impact received from Cordis in this ongoing effort to promote on patient care. research and advance the careers of promising young This year’s applications “were of extremely high quality,” researchers. “Each year these grants encourage and said Committee Chair William G. Kussmaul, M.D., FSCAI. support the best cardiology fellow projects. We are deeply “The proposals submitted by Drs. Dori and Gertz were chosen appreciative of Cordis’s commitment to this program and because they tackled difficult clinical issues promoting to encouraging the future of interventional cardiology.” patient-centered clinical catheterization research.” “The Cordis Cardiac & Vascular Institute is dedicated Dr. Dori received the SCAI/Cordis research grant for to advancing potential treatments for those who suffer his project, “Measurement of Diastolic Function Using from cardiovascular disease, and we are proud to support Custom-Made High-Fidelity MRI-Compatible Pressure research grants like these that may lead to a positive Sensor Tipped Catheters and Real-Time MRI.” Dr. impact on patient care,” said Sheila Weston, manager of Gertz’s award-winning proposal is titled “A Case-Control Medical Affairs and Grants at Cordis Corporation. Study of the Functional Significance of Internal Pudendal For more information about next year’s research Artery Stenoses in Patients with Erectile Dysfunction and fellowship awards programs, visit www.SCAI.org. n Coronary Artery Disease.”
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SCAI 2010 SCAI Presents Second Gregory Braden Memorial Fellow of the Year Award
Dr. Nicholas Ruggiero received the Second Annual Gregory Braden Memorial Fellow of the Year Award in recognition of skill, potential, and dedication to his patients – qualities that Dr. Braden fostered in the many young interventionalists he helped train.
S
CAI presented the Second Annual Gregory Braden Memorial Fellow of the Year Award to interventional cardiologist-in-training Nicholas Ruggiero, M.D., during the Society’s 33rd Annual Scientific Sessions in San Diego. A committee of physicians selected Dr. Ruggiero based on his dedication to cardiovascular investigation and pursuit of academic excellence, both reminiscent of Dr. Braden’s legacy. Dr. Braden was known throughout the cardiovascular community for his commitment to teaching. His wife, Mrs. Marion Braden, fondly recalls the hours he spent helping answering fellows’ questions. “Greg would not leave a fellow’s side until every question was completely answered,” she remembered. “His dedication to the fellows
Dr. Howard Hermann
Dr. Maurice Buchbinder
led his family to want to contribute and encourage fellowsin-training to find a cure for coronary disease.” “Working with Mrs. Marion Braden, SCAI established this special award to honor Greg’s memory and to continue his legacy as a renowned interventional cardiologist, teacher, and researcher,” said SCAI Immediate Past President Steven R. Bailey, M.D., FSCAI. Candidates for the Gregory Braden Memorial Fellow of the Year Award are evaluated based on their interventional skills in multiple modalities, personal contribution to cardiovascular research, authorship in cardiovascular research journals, promise for making contributions to cardiovascular research, and dedication to patient care and well-being. When nominating Dr. Ruggiero, his mentors wrote enthusiastically of his skill, potential, and dedication to his patients. Dr. Ruggiero graduated magna cum laude from Jefferson Medical College, where he also completed his internship, residency, and cardiovascular fellowship. His cardiology, interventional coronary, and structural cardiology fellowships were completed at Massachusetts General, where he will also be a fellow in diagnostic and interventional vascular medicine. Dr. Ruggiero has published over 15 original papers and has presented at more than 10 national and international meetings. Mrs. Braden presented Dr. Ruggiero with a crystal plaque, a $5,000 grant, and a complimentary membership in SCAI for one year. Dr. Ruggiero is the second of five recipients who will be named Gregory Braden Fellows. SCAI thanks the Forsyth Medical Center Foundation for sharing the Society’s commitment to honoring the memory of Dr. Braden. For more information on the Gregory Braden Memorial Fellow of the Year Award, visit www.SCAI.org or email Laura Brown at LBrown@scai.org. n
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Industry Acknowledgments SCAI expresses deep appreciation for the generous support from the following companies, helping to make the SCAI 2010 Scientific Sessions a HUGE success.
GOLD
SCAI also appreciates the in-kind support of educational simulators from:
• Abbott Vascular • Boston Scientific
• Terumo Medical Corporation
SCAI Thanks:
SILVER
• ACISTMedical • LightLab Imaging • Medtronic
• Cordis Cardiac & Vascular Institute • Medtronic • The Medicines Company
SCAI ALSO THANKS:
BRONZE
• AstraZeneca • Bristol-Myers Squibb/ Sanofi Pharmaceuticals Partnership • Cook Medical • Daiichi Sankyo Lilly • St. Jude Medical
• C ordis Cardiac & Vascular Institute for its generous educational grant support of the 7th Annual Interventional Fellows Complex Coronary Complications (C3) Summit • Cordis Cardiac & Vascular Institute for its support of the 2010 SCAI/Cordis Fellowship Program for Interventional Cardiology
SCAI Welcomes New Trustees SCAI is pleased to welcome the following Fellows to the Board of Trustees or the Executive Committee:
SCAI also thanks the following Fellows whose terms as Trustees or Executive Committee members ended in May 2010. Their service to the Society is gratefully acknowledged:
Theodore A. Bass, M.D., FSCAI Secretary, SCAI Jacksonville, FL
Jeffrey Cavendish, M.D., FSCAI San Diego, CA
Anthony Farah, M.D., FSCAI Pittsburgh, PA
Robert M. Bersin, M.D., FSCAI Seattle, WA
Christopher U. Cates, M.D., FSCAI Atlanta, GA
David A. Cox, M.D., FSCAI Allentown, PA
James Hermiller, M.D., FSCAI Indianapolis, IN
Thomas Jones, M.D., FSCAI Seattle, WA
Upendra Kaul, M.D., FSCAI New Delhi, India
Ziyad M. Hijazi, M.D., MPH, FSCAI Immediate Past President, SCAI Chicago, IL
Ian T. Meredith, M.D., FSCAI Melbourne, Australia
Timothy A. Sanborn, M.D., FSCAI Chicago, IL
Clifford Kavinsky, M.D., Ph.D., FSCAI Chicago, IL
Ahmed Magdy, M.D., FSCAI Cairo, Egypt
J. Jeffrey Marshall, M.D., FSCAI Vice President, SCAI Gainesville, GA
Ashok Seth, M.D., FSCAI New Delhi, India
Jonathan M. Tobis, M.D., FSCAI Los Angeles, CA
Mark A. Turco, M.D., FSCAI Takoma Park, MD
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Coding Q&A Reporting Renal Angiography – Now and On the Horizon
Q:
How do I report renal or iliac angiography when the contrast injections are performed from the aorta and the vessels are not actually selected, with the catheter placed only at the origin of the artery and not actually placed in the vessel?
A:
If the catheter is not placed into the vessel, it is considered a “non-selective” study. Nonselective renal vessel imaging is typically inherent to abdominal aortography, and this work is typically captured through reporting the applicable aortography code (75600, 75605, 75625, or 75630) in conjunction with the non-selective catheter code 36200. Code 75625 describes a full and complete study of the abdominal aorta. Code 75716 describes a full and complete study of both lower extremities. Code 75630 describes a study of the abdominal aorta and iliofemoral arteries bilaterally. By convention, code 75630 is used when all imaging is done from a single catheter position or when limited imaging of the lower extremity vessels is done. Codes 75625 and 75716 are reported when complete studies of the abdominal aorta and of the lower extremities are done, necessitating repositioning of the catheter with fluoroscopic guidance to achieve optimal imaging detail. However, when non-selective renal or iliac angiography is performed in conjunction with a heart catheterization procedure, special G-codes are used to report these services. In 2003, the Centers for Medicare and Medicaid Services (CMS) issued G-codes to report non-selective renal and iliac angiography (G0275 and G0276, respectfully) performed at the time of a cardiac catheterization; physicians must use these codes when reporting these services under the Medicare program. G0275 Renal angiography, non-selective, one or both kidneys, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of any catheter in the abdominal aorta at or near the origins (ostia) of the renal arteries, injection of dye, flush aortogram, production of permanent images, and radiologic supervision and interpretation (list separately in addition to primary procedure). G0278 Iliac and/or femoral artery angiography, nonselective, bilateral or ipsilateral to catheter insertion, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of the catheter in the distal aorta or ipsilateral femoral or iliac artery, injection of dye, production of permanent images, and radiologic supervision and interpretation (list separately in addition to primary procedure).
If selective renal angiography is performed either in conjunction with, or independently from, cardiac catheterization, code 75722 or 75724 is reported for unilateral or bilateral renal angiography, respectively. The vessel(s) must be selectively catheterized to report either code 75722 or 75724. Selective catheterization is coded following established coding depending on how far into the vessel the catheter is advanced (see codes 36245–36248). Modifier use may be necessary when selective catheterization is reported in conjunction with cardiac catheterization, as the selective catheterization codes and cardiac catheterization codes both include the work of non-selective catheter placement into the aorta. Ipsilateral iliac angiography from a selective catheter position is inherent to unilateral extremity angiography (code 75710) and is only separately reportable if this work is not already captured as part of another reportable angiography code. There is not any additional catheterization code reported when the catheter is retracted back through the ipsilateral iliac for additional study. Bilateral iliac angiography from selective catheter positions are inherent to bilateral extremity angiography (code 75716), and this work is only separately reportable if not already captured as part of another reportable angiography code. When the catheter is positioned in the contralateral iliac for contralateral leg arteriogram, and then pulled back into the ipsilateral iliac for ipsilateral leg arteriogram, (code 75716) is reported in conjunction with selective catheterization following established coding conventions. Modifier use may be indicated when selective catheterization is reported in conjunction with cardiac catheterization as the selective catheterization codes and cardiac catheterization codes both include the work of non-selective catheter placement into the aorta. CMS and the AMA RUC (RBRVS Update Committee) have targeted selective renal angiography for bundled code development. New bundled codes that will be inclusive of catheter placement are expected to be developed over the next year by a multispecialty coalition in which SCAI is an active participant. SCAI anticipates new codes will be issued in 2012. n Please note: SCAI is committed to making every reasonable effort to provide accurate information regarding the use of CPT®, and the rules and regulations set forth by CMS for the Medicare program. However, this information is subject to change by CMS and does not dictate coverage and reimbursement policy as determined by local Medicare contractors or any other payor. SCAI assumes no liability, legal, financial, or otherwise, for physicians or other entities who utilize this information in a manner inconsistent with the policies of any payors or Medicare carriers with which the physician or other entity has a contractual obligation. CPT codes and their descriptors are copyright 2009 by the American Medical Association.