Abstract
Background/Purpose
Compared with trans-femoral percutaneous coronary intervention (TFI), trans-radial PCI (TRI) has a lower risk of bleeding, access site complications and hospital costs, and is preferred by patients. However, TRI accounts for a minority of PCIs in the US, and there is currently little research that explores why.
Methods/Material
We conducted a national survey in February 2013 to assess perceptions of TRI vs. TFI, and barriers to TRI adoption and implementation among interventional cardiologists employed by the US Veterans Health Administration (VHA), and linked these data to site-level TRI annual rates for 2013.
Results
We received 78 completed surveys (32% response rate). Respondents at sites that perform few or no TRIs identified increased radiation exposure as the greatest barrier while at sites that perform a high percentage of TRIs respondents identified the steep learning curve as the greatest barrier. Majorities of survey respondents at all sites rated TRI as superior on 5 of 7 criteria, including patient comfort and bleeding complications, but rated TFI as superior on procedure time and procedure success.
Conclusions
Even interventional cardiologists at sites that perform few or any TRIs recognized the superiority of TRI for patient comfort and safety, but rated it inferior to TFI on procedure time and technical results. Interventional cardiologists at high-TRI labs rated TRI as equivalent on procedure time and technical results. Efforts to increase TRI adoption and implementation may be more successful if they emphasize that procedure times and technical results depend on achieving proficiency.
Highlights
- •
Sites with few TRIs identified increased radiation exposure as the greatest barrier.
- •
Sites with many TRIs identified the steep learning curve as the greatest barrier.
- •
TFI was rated superior on procedure time and procedure success.
- •
TRI was rated superior on all other criteria.
1
Introduction
Trans-radial percutaneous coronary intervention (TRI) is an evidence-based, patient-centered alternative to trans-femoral PCI (TFI) in the treatment of patients with chronic and acute coronary artery disease . Relative to TFI, TRI reduces the risk of vascular and bleeding complications by 78% and the need for transfusion by 80% . Both observational and randomized trial data show that TRI is associated with lower total hospital costs . Most importantly, radial access offers greater patient comfort, including lower bodily pain, lower back pain and greater walking ability, as well as earlier hospital discharge .
Despite the advantages of TRI, TFI has historically been the dominant access approach in the United States (US), and adoption of TRI in the US continues to lag behind other countries . National registry data indicate that the radial artery approach accounts for approximately 16% of percutaneous coronary interventions performed in the US . The figure is similar in the US Veterans Health Administration (VHA), and currently only nine of the 65 VHA facilities that perform PCI use TRI in more than 50% of cases .
However, the reasons for this limited uptake are unclear. Some have suggested that there is a lack of compelling motivation for operators to switch to radial access; a dearth of training opportunities; significant logistical requirements, including having the support of cath lab staff and the availability of the right equipment; and a significant learning curve that, initially, entails longer procedures times and failures (i.e., failure via trans-radial and need to operate via femoral access) . However, there has been little empirical study to systematically identify barriers to TRI adoption, and assess their prevalence and their association with TRI rates.
To help close this gap, we conducted a national survey to assess the prevalence of attitudes about and barriers among interventional cardiologists performing cardiac interventions in the VHA. We report descriptive findings.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
