A look around the evolving cath lab

por John R. Fischer, Senior Reporter | March 09, 2020
Cardiology Operating Room
From the March 2020 issue of HealthCare Business News magazine

Many require a team of diverse talents, such as a heart team to perform TAVR. This can consist of cardiac surgeons, interventional cardiologists, cardiac imaging specialists, noninvasive cardiologists, and radiologists, among others. Experts agree that the best way of managing a cath lab and the diverse needs of clinicians and staff in there is to have a leadership team in place that is physician-managed.

“I have always found better decisions are made if you keep the patient as the focus and make the decisions for best possible clinical outcomes for the patient,” said Dr. Ehtisham Mahmud, professor and division chief of cardiovascular medicine at the University of California, San Diego, and president of the Society for Cardiovascular Angiography and Interventions (SCAI). “If the decisions regarding equipment or operations of a cath lab or healthcare delivery are made by a leadership team that is physician led, it almost always is better than one where financial decisions are made by administration alone or by non-clinicians.”

Encouraging carotid collaboration
While heart teams exist for addressing vascular and structural heart problems, there is no formally established carotid team dedicated to addressing conditions affecting the coronary arteries.

“When you’re doing any type of revascularization or cardiac procedure, whether it’s CABG versus PCI or SAVR versus TAVR, there has to be a team approach. That never developed in most places in the carotid arena,” said Marshall. “It’s sad that it did not occur because there is clinical equipoise between carotid aortic atherectomy and carotid stenting.”

The lack of a team contributes to the inability at times to perform certain procedures such as carotid stenting, which is underutilized in the U.S., according to Marshall. He partially attributes this underutilization to National Coverage Determination not demanding a carotid team. In contrast, the National Coverage Determination for TAVR required that there be a heart team.

“The thing that’s different between the carotid environment and structural heart disease environment is that in the carotid one, you’re talking about a single operator,” says Bonnie Weiner, chief medical officer for ACE. “What it came down to, in terms of the difficulty, were turf wars. For structural heart disease, in addition to the evaluation of patients in heart team environments — at least in the early stages — there have been surgeons side-by-side with interventional cardiologists actually doing the procedures.”

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