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[Interventional cardiology--can medical and economic requirements be united?]
1Rotes-Kreuz-Krankenhaus, Abt. Kardiologie, Frankfurt/Main.
Insights
Private practices can offer interventional cardiology, including percutaneous transluminal coronary angioplasty (PTCA), by prioritizing high-risk patients and maintaining quality control. This approach demonstrates that economic viability and excellent medical outcomes are achievable in private practice settings.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
Context:
- Challenges in private practice interventional cardiology include patient selection and service availability.
- Potential for PTCA indications to be broadened beyond medical necessity.
- Concerns regarding the profitability of 24-hour emergency services in private settings.
Purpose:
- To evaluate the feasibility and outcomes of interventional cardiology in private practice.
- To demonstrate that private practices can manage high-risk patients effectively.
- To explore the integration of economic and medical considerations in private cardiology.
Summary:
- Over 6300 PTCA procedures were performed, with 83% of patients having complex stenoses (Type B/C).
- High rates of multivessel disease (48%) and unstable angina (36%) were observed.
- The institution achieved a 92.2% success rate with low complication rates (0.3% emergency CABG, 0.3% in-hospital mortality).
- Factors contributing to success include high patient volume, continuous quality control, and reinvestment in staff and equipment.
Impact:
- This model shows that private interventional cardiology can be both medically successful and economically sound.
- Recommends extending benefits to non-private labs and establishing universal quality control programs.
- Highlights the importance of experience, quality assurance, and resource investment for successful outcomes.
Abstract:
Interventional cardiology in a private practice might be problematic for the following reasons: 1) High-risk patients might be rejected in order to avoid complications. 2) The indication for PTCA might be extended to "cosmetic cases". 3) Over cautious dilatation (residual stenosis greater than 50%) might save time and expensive balloon-material. 4) A 24-hour service is unprofitable and might therefore not be offered. This, however, is not acceptable according to medical, ethical, or entrepreneurial reasons, and it is not the philosophy of the two private practices which currently perform PTCA in Germany in Hospital settings. From 1986-1990, 6300 PTCA-procedures were performed in our institution: 83% of patients had complicated stenoses (type B/C), 48% had multivessel disease, 36% had unstable angina, 16% EF less than 40%, and 9.8% were older than 70 years. More than 50% came from other hospitals with catheterization facilities. The primary success rate was 92.2% (stenoses) and severe complications were rare: emergency-CABG 0.3%, in hospital mortality 0.3%. The reasons for this extremely low complication rate are: 1) Large experience due to high volume. 2) Continuous quality control. 3) Much of the profit is reinvesed in employees and equipment hardware. Our example illustrates that economical aspects are not necessarily inconsistent with medical aspects. If interventional cardiology will be extended to other private practices, however, it seems crucial to: 1) allow benefit also to non private laboratories (university, general hospital), 2) establish a program of quality control for all institutions.