Cath Lab Digest - November 2007 - (Page 10)

10 CUTTING-EDGE CASES NOVEMBER 2007 continued from previous page an important aspect in the management of DES patients. Current AHA/ACC/SCAI guidelines stress the importance of dual antiplatelet therapy after placement of a DES, and highlight the need to educate patients about the hazards of stopping their medication early. Q A Why aren’t patients more adherent to physician-prescribed medications? It is multi-factorial, but there are three main reasons for non-compliance to medications. First of all, patients are usually overwhelmed with information and they do not remember everything their physicians tell them, despite our best efforts to educate our patients. This is why it is important to not only have a conversation with the patient but also to provide additional information that reinforces the importance of antiplatelet medications that he or she can refer to after discharge. Forgetfulness is another common reason for non-adherence. Patients either forget to take their medication on a daily basis, or forget to refill their prescriptions. Additionally, some patients may not be able to afford the medication. The Stentplus™ Program is designed to address each of these reasons for non-compliance. How will the Stentplus Program address patient non-compliance? There are three key aspects of the program, designed to address the multiple factors of non-compliance. First, the program includes patient education materials describing the treatment of CAD, an overview of angioplasty and stenting, and ways for patients to make a positive impact on their disease, including the importance of adhering to antiplatelet drugs. The education materials will be available on a DVD, a written manual and through the Stentplus Program website. Another part of the program includes personalized services to remind patients to take their medications each day and to refill their prescription on a monthly basis. These reminders are especially important to support patients in taking their physician-prescribed medications for the full duration of their script. Finally, the program includes resources that detail available financial assistance programs to make it easier for patients who are not financially able to afford medication to find assistance. Will cath lab staff, such as nurses and technologists, have a role in the Stentplus Program? How about patient family members? Cath lab staff will play an integral role in the success of the program. Everyone who comes in contact with the patient has the opportunity to assist physicians in conveying the importance of taking antiplatelet therapy after a DES procedure. The tools included in the Stentplus Program will help facilitate these most important discussions with patients. The Stentplus Program also encourages family members to play an active role in understanding stenting therapy and providing support to their loved ones. Family members are one of the most powerful allies in patient management. If a patient cannot remember all of the details of a conversation with his or her physician, having a family member or a close friend along on the visit is helpful. Q A How are you planning to incorporate the program into your practice? I plan to provide my DES patients with the Stentplus Program materials. I also plan to pass along program information to referring cardiologists so they can educate patients before they get to the cath lab. Non-invasive cardiologists and primary care physicians typically have more contact with patients than interventional cardiologists, so it is extremely important that they assist in stressing the importance of dual antiplatelet therapy. The Stentplus Patient Success Program is sponsored by Boston Scientific Corporation; reviewed and endorsed by The Society for Cardiovascular Angiography and Interventions. Sponsored by Boston Scientific Corporation Figure 2. Percutaneous angioplasty of the right distal superficial femoral artery (SFA). Successful wire crossing from dorsalis pedis Post balloon angioplasty Final distal runoff Q A documented at the end of the procedure. Elective amputation of the osteomylitic right second toe was performed and antibiotics were administered. Complete wound healing was noted at two months and follow-up ABI was 0.92 in the right leg. Discussion Complex vascular cases are unique and need a multi-disciplinary approach for the best outcomes. Such combined efforts lead to reduced morbidity, mortality, better patient outcomes, excellent multi-specialty collegial work and a high success rate. At our center, the weekly combined vascular conference gives us the venue to discuss complex cases. Physicians with both surgical and cardiology background provide a planning and strategy to approach complex vascular cases. Such an approach reduces the animosity, turf wars and keeps transparency in patient care. A complex case presented at the conference will have the input from experienced surgeons and the chance to discuss some of the literature. New research ideas are born and nurtured at these conferences. This multidisciplinary approach is of tremendous learning venue to the participating physicians, residents, students and cardiology fellows. The operating room assistants bring all the required equipment to the catheterization laboratory and assist the surgeon for such procedures. The cath lab has a state-of-the-art Philips flatscreen 20-inch image intensifier that provides adequate visualization of the arterial vasculature anywhere in the body. The laboratory is routinely used for both coronary and peripheral procedures. The vascular surgeons and the cardiologists have open access to the cath lab use. The cath lab consists of Q A dedicated nurses and technologists who have a passion for peripheral procedures. The technologists, nurses and the lab personnel play a big role in the success of these procedures. Complex cases can take 4 hours and various catheters and equipment are needed routinely. Extra patience and support from the staff at our center has played a pivotal role in our success. We have had the fortune of working on complex cases in close relationships with the vascular surgeons and other cardiologists, including Dr. Steven Powell (Chief of Vascular Surgery at East Carolina University). Dr. Powell was the vascular surgeon in the case described above and has also worked with us on complex iliac interventions and carotid interventions. Dr. Michael Stoner (Assistant Professor of Vascular Surgery at East Carolina University) has assisted us numerous times in complex PVI utilizing the popliteal access site for SFA interventions and abdominal aortic aneurysm stent grafting. As the number of vascular procedures increases, the need for a multi-disciplinary approach to these complex vascular lesions is an important strategy for optimizing patient care options. ■ The authors can be contacted at dappamd@yahoo.com References 1. Dotter CT, Judkins MP. Transluminal treatment of arteriosclerotic obstruction. Description of a new technic and a preliminary report of its application. Circulation 1964;30:654–670. 2. Levin DC, Parker. L, Eschelman DJ, et al. Do interventional radiologists pose a significant threat to the practice of vascular surgery? J Vasc Interv Radiology: 1999 Sep;10(8): 1007–1011. 3. Levin DC, Rao VM, Parker L, et al. Turf wars in radiology: the battle for peripheral vascular interventions. J Am Coll Radiology 2005 Jan;2(1):39–42. 4. CxVascular. Turf wars intensify over endovascular training. Available at: http://www.cxvascular.com/News/News.cfm?ccs=276&cs=180 4. Accessed October 16, 2007. Note: This article underwent double-blind peer review by members of the Cath Lab Digest Editorial Board. http://www.cxvascular.com/News/News.cfm?ccs=276&cs=180 http://www.cxvascular.com/News/News.cfm?ccs=276&cs=180

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

Henry Ford Heart and Vascular Institute Treating Patients with Complex Vascular Disease with a Multi-Disciplinary Approach Improving Patient Compliance with Antiplatelet Medications Clinical Editor’s Corner Cath Lab Nurse/Tech Vascular Access and Closure Using the StarClose® Device The Clinical and Economic Impact of Measuring Fractional Flow Reserve FFR and Choosing an Optimal Revascularization Strategy Finally! The New Registered Cardiac Electrophysiology Specialist (RCES) Credential Use of a Mobile Lab to ‘Test the Waters’ at a Rural Hospital Remembering a Cardiac Cath Lab History ACVP• Membership Page What Do You Think? The Ten-Minute Interview with… Ernie Livingston, RN, BSN SICP* Chapter Updates Who’s in Charge? Working to Eliminate Bottlenecks: Florida Hospital’s Cardiac Cath Lab Achieves Greater Efficiency and Higher Satisfaction Preserving Left Ventricular Function during Percutaneous Coronary Intervention Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab Making the Most of Your First Impression: Interviewing Tips and Techniques CEU Education Center Clinical & Industry News Meetings Calendar

Cath Lab Digest - November 2007

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