Cath Lab Digest - October 2007 - (Page 61)

OCTOBER 2007 CATH LAB COSTS 61 Cost-Effectiveness of the Radial versus Femoral Artery Approach to Diagnostic Cardiac Catheterization Oleg Roussanov, MD, S. Jeanne Wilson, RN, Katherine Henley, FNP, Greta Estacio, FNP, Judith Hill, FNP, Brenda Dogan, RN, William F. Henley, PhD, Nabil Jarmukli, MD Cardiology Section, Salem VA Medical Center Salem, Virginia ABSTRACT: Background. The radial approach to cardiac catheterization is increasingly popular due to shorter procedural and recovery times, and greater patient comfort. Methods. Comparative cost analysis between radial or femoral (with/without closure device) approaches were performed. Results. Radial (R), femoral (F), and femoral with a closure device (F ± C) approaches were used in 70, 62 and 49 consecutive cases, respectively. Group R had higher access equipment cost ($93.0 ± 9.5 vs. $40.5) than Group F (p < 0.001), but lower catheter cost ($19.7 ± 12.7 vs. $31.1 ± 9.3; p < 0.001) than Group F, and lower contrast cost ($26.9 ± 17.0 vs. $42.9 ± 25.0) than Group F ± C (p < 0.001). There was a lower post-procedure recovery cost ($185.2 ± 52.7) in Group R compared to $337.5 ± 59.0 in Group F (p < 0.001) and $208 ± 70.4 in Group F ± C (p < 0.001), with a median recovery time of 126.0 ± 36.0 minutes in Group R vs. 240.0 ± 42.0 minutes, and 150.0 ± 48.0 minutes in Groups F and F ± C, respectively (both p < 0.05). The total variable procedural cost, which includes approach-dependent equipment and recovery room stay, was significantly lower in the Radial Group than in the Femoral Group ($369.5 ± 74.6 vs. $446.9 ± 60.2 and $553.4 ± 81.0; p < 0.001). Conclusion. The radial artery approach to diagnostic cardiac catheterization is clearly more cost effective than the femoral approach, with or without the use of a femoral closure device. This article is reprinted with permission from J INVASIVE CARDIOL 2007;19(8):349–353. Table 1. Patient baseline characteristics. Proportions were tested for significant differences with the chi square procedure; means were tested using ANOVA. Demographics Age Hypertension Diabetes mellitus Congestive heart failure Chronic renal failure Cerebral vascular disease Peripheral vascular disease Prior myocardial infarction Radial 63.0 ± 9.0 31 (81.6%) 19 (50%) 3 (7.9%) 1 (2.6%) 2 (5.3%) 4 (10.5%) 13 (34.2%) Femoral 66.0 ± 10.0 38 (84.4%) 16 (35.6%) 3 (6.7%) 7 (15.6%) 1 (2.2%) 3 (6.7%) 13 (28.9%) Femoral p-Value w/Closure 61.0 ± 11.0 0.90 25 (78.1%) 0.26 14 (43.8%) 0.68 3 (9.4%) 1.00 3 (9.4%) 0.08 2 (6.3%) 0.82 1 (3.1%) 0.42 12 (37.5%) 0.97 Table 2. Cardiac catherization findings. Proportions were tested for significant differences with the chi square procedure; means were tested using ANOVA. Results 1-vessel disease 2-vessel disease 3-vessel disease 2- and 3-vessel disease Ejection fraction, % Radial 11 (29.0%) 8 (21.1%) 6 (15.8%) 14 (36.8%) 57 ± 9.5 Femoral p-Value w/Closure 68 (17.8%) 7 (21.9%) 0.61 9 (20.0%) 5 (15.6%) 0.55 8 (17.8%) 4 (12.5%) 0.51 17 (37.8%) 9 (28.1%) 0.29 54.6 ± 10.2 55 ± 9.3 0.46 Femoral T he radial artery approach to diagnostic cardiac catheterization has emerged as an attractive alternative to the femoral artery approach in recent years, especially in Canada and Europe, due to more familiarity and training.1,2 In experienced hands, the radial approach has been shown to minimize patient discomfort, and achieve early ambulation and discharge,3,4 with a reduced incidence of bleeding and other vascular complications compared with the femoral approach.5–8 Cost comparisons have been made between the radial and femoral approaches to diagnostic cardiac catheterization, demonstrating reduced cost with the radial approach.3,9–11 However, previous studies did not include patients who received femoral puncture closure devices. Therefore, we sought to determine the cost effectiveness of the radial artery approach to diagnostic cardiac catheterization compared with the femoral artery approach in two groups, one with and one without the utilization of closure devices. Methods Patient population. Patients who underwent diagnostic cardiac catheterization between October 2004 and December 2005 at Salem Veterans Affairs Medical Center were identified for cost analysis. Patients were excluded if they required additional adjunct procedures such as coronary intervention, peripheral angiography or intervention, right heart catheterization, cardiac biopsy, intra-aortic balloon pumping or coronary artery bypass graft cannulation. Catheterization approaches. The femoral approach was performed through the right or left femoral artery based on femoral pulse strength, patient anatomy and operator discretion, using 18-gauge, 70 mm-long Cook needles (Cook, Inc., Bloomington, IN), and 5 or 6 Fr Cordis sheaths (Cordis Corp., Miami, FL) and Judkins catheters. At the end of the procedure, the femoral sheath was removed and hemostasis was achieved either manually, with a mechanical device, or using a closure device — the Angio-Seal™ (St. Jude Medical, St. Paul, Minnesota) or Perclose® (Abbott Vascular, Abbott Park, IL). The radial approach was performed only in patients who had a normal Allen’s test, preferentially through the right radial artery. Access into the radial artery was achieved using a 21-gauge, 25 mm-long Cook needle. This was followed by the introduction of a 5 Fr Cook Flexor Check-Flo Performer Introducer set with hydrophilic coating. Then a “cocktail” of nitroglycerin (50 mcg), heparin (2,000 U), lidocaine 1% (10 mg), verapamil (1.25 mg) and 0.9% normal saline (3.5 cc) was injected intra-arterially through the radial introducer. A 5-Fr multipurpose MPA 2 Cordis catheter was the initial choice in all patients. At the end of the procedure, hemostasis was achieved with manual compression and a D-Stat Radial band (Vascular Solutions, Inc., Minneapolis, MN). Our catheterization laboratory policies for recovery times were concordant with the 2001 ACC/SCAI Catheterization Standards recovery times of 2–6 hours for the femoral approach and 1–2 hours for the radial approach. All femoral and radial procedures were performed by the same operator. Data collection. Patient demographics and catheterization data were obtained through the Veterans Administration computerized electronic medical record (CPRS), the Witt monitoring system (Philips Medical, Bothell, WA) and the catheterization laboratory and recovery area nursing notes and quality management data. Cost analysis. Hospital cost was obtained from the Veterans Administration accounting office. This included the cost for needles, sheaths, wires, catheters, closure devices, medications and nurse/technologist utilization recovery cost. Statistical analysis. Variables of interest were analyzed to determine normality of distribution. Pair-wise comparisons between the three groups were performed using the two-tailed unpaired t-test. Results Patient population and demographics. Between October 2004 and May 2006, a total of 181 patients who underwent diagnostic cardiac catheterization at Salem Veterans Affairs Medical Center were selected for the cost analysis. Seventy patients were in the Radial Group (R), 62 patients in the Femoral Group without the closure device (F) and 49 patients in the Femoral Group with the closure device (F ± C). The mean age was 63 ± 9 years in Group R

Table of Contents Feed for the Digital Edition of Cath Lab Digest - October 2007

Saints Medical Center Fibromuscular Dysplasia in Children and Adolescents Cerebral Vascular Accident Following a Pulmonary Embolism: Search for the Hidden Patent Foramen Ovale Contents Clinical Editor’s Corner Meetings Calendar CEU Education Center Radiation Tracking in the Cardiac Catheterization Lab Letter to the Editor Carotid Stenting: An update Release from Stent-jail: Beneficial Snow-Plowing? Patient Management Guidelines Searching for a Cardiovascular Position? Tips for Creating a ‘Stand-Out’ Resume Long-Term Implications of Short-Term Closure Decisions – The Evolution to Vascular Access Management and the Boomerang Catalyst System The Ten-Minute Interview with… Angie Bowles, RN, CCRN CMS Issues Final FY 2008 IPPS Rule ACVP• Membership Page Experience with a New Workhorse Guidewire Ask the Clinical Instructor: Q&A for Those New to Cath Lab A Glimpse of the Future of Clinical Education: Boston Scientific’s SimSuite Bus Visits Carnegie Institute 2007 Educational Fair Held at the Washington Hospital Center Research Update: Original Contribution Abstracts from The Journal of Invasive Cardiology What Do You Think? A Virtual Cath Lab Viewer (VCL): The Development of an Online 3D C-arm Simulator and Coronary Anatomy Viewer Clinical & Industry News Cost-Effectiveness of the Radial versus Femoral Artery Approach to Diagnostic Cardiac Catheterization

Cath Lab Digest - October 2007

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.