In This Issue:
CCI: Renal Stenting Lowers Blood Pressure in Severe Hypertension
Patients with uncontrolled renovascular hypertension saw a significant improvement in their blood pressure with renal artery stent deployment in HERCULES Trial data reported in the September issue of Catheterization & Cardiovascular Interventions (CCI). The multicenter HERCULES trial, evaluating the safety and effectiveness of the RX Herculink Elite Stent, found that patients with higher blood pressure levels at baseline had the most dramatic reduction in blood pressure following intervention.
Findings from the HERCULES trial expands scientific evidence of renal artery stenting in treating patients with high blood pressure who do not respond to standard therapy," explains Michael R. Jaff, DO, FSCAI, from the Vascular Center at Massachusetts General Hospital in Boston. "As part of the trial we also explored the predictive value of the brain natriuretic peptide (BNP) test prior to performing the stent procedure." The BNP test is used to diagnosis heart failure and researchers sought to understand if BNP could predict clinical success, which is valuable information for interventionists prior to performing invasive procedures.
For the HERCULES trial researchers enrolled 202 patients with 241 total lesions and 78 bilateral lesions between August 2007 and October 2009. Patients had a history of high cholesterol levels and active or recently discontinued tobacco use. The majority of participants were Caucasian, mean age was 72 years, and 62% of patients were female. BNP testing was performed before and after stenting.
At the start of the trial the mean systolic blood pressure of the trial group was 162 mm Hg and nearly 70% of patients were taking three or more medications to control hypertension. Success rates for the trial device, procedure and clinical outcomes were 96%, 99%, and 98%, respectively. Researchers reported that freedom from major adverse events (death, kidney removal, or embolism causing renal injury) was 95%.
Further results show that at the nine-month follow-up the restenosis rate was 11% and the mean systolic blood pressure for participants was 145 mm Hg post-stenting with no change in medications. Researchers found no association between a reduction in blood pressure following stenting and elevated BNP pre-procedure, or a decrease in BNP levels following successful stenting. While there was significant decrease in BNP following stenting, the BNP level prior to the procedure was not reliable in predicting blood pressure response.
More Information on the Trial Findings
Dr. Michael Jaff Discusses What YOU Need to Know About Patient Selection
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In Case You Missed It: SCAI Issues FAME 2 Tools for YOU & Your Patients
SCAI President J. Jeffrey Marshall, MD, FSCAI issued the email below to SCAI members on Tuesday:
Today the results of FAME 2 were presented at the European Society of Cardiology Congress and published in the New England Journal of Medicine. FAME 2 is an important trial for our profession and our patients, potentially impacting how we make therapeutic decisions for our stable ischemic heart disease patients and how our treatment of these patients is perceived in terms of appropriateness.
Over the past few days, SCAI has discussed the results of this study with journalists while also preparing the attached materials, which you may wish to use in your discussions with colleagues, reporters and patients.
- President’s Page: “The Benefit of Ischemia-Based Revascularization for Stable Ischemic Heart Disease: The Impact of FAME 2”. In order to promote robust and timely discussion of FAME 2, SCAI has e-published this President’s Page on www.SCAI.org in advance of print publication in Catheterization and Cardiovascular Interventions (CCI). I hope it will be helpful to you in conversations with colleagues.
- News release. SCAI has distributed this statement to journalists. I encourage you to use it as a guide if you are interviewed.
- Patient education tool. Please download and print this PDF to share with your patients and their families. You may also wish to refer them to SCAI’s public education website, www.SecondsCount.org, where news from FAME 2 is highlighted.
- Coding information. Have questions about reimbursement for FFR? CLICK HERE for answers from SCAI on what cardiologists and coders should know.
My thanks go out to SCAI Public Relations Committee members Ajay J. Kirtane, MD, SM, FSCAI, and John P. Reilly, MD, FSCAI, who were instrumental in developing these materials and fielding interviews.
I would appreciate your thoughts. Please email me at firstname.lastname@example.org .
J. Jeffrey Marshall, MD, FSCAI
SCAI President (May 2012 - May 2013)
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FFR & Reimbursement: What Cardiologists & Coders Should Know
Following publicity around FAME 2, many cardiologists and their coding staff may have questions about reimbursement for fractional flow reserve (FFR). SCAI fought for add-on payments for the use of FFR technology, succeeding in obtaining CPT® code 93571 and the additional payment average allowed charge of $91 but not in getting additional payments for hospitals. Although SCAI leveraged the support of a CMS-convened hospital payment advisory board, the agency continues to say FFR is a bundled procedure included in the facility's inpatient and outpatient payment groups.
SCAI data analysts have noted a small but rapidly growing number of FFR procedures being billed to Medicare, rising from 22,000 in 2010 to 28,000 in 2011. It may be that some coding staff are assuming that a procedure not separately billable for the hospital is not separately billable by the physician. SCAI suggests checking with coding staff to ensure they are billing for FFR whenever it is used.
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SCAI RAMP: Delivering Transradial Training Directly to Your Facility!
Aimed at medical centers and multispecialty practices, SCAI's Radial Access Mentorship & Preceptorship (RAMP) Program delivers on-site, in-person transradial training from physicians with extensive transradial experience.
No other society offers this type of education! SCAI RAMP advances how transradial intervention is taught by moving it beyond the classroom training approach and into your facility.
Even better as Program Director Adhir Shroff, MD, FSCAI points out, "RAMP offers a completely unbiased and brand-neutral education that is ideal for hospital administrators and physicians who agree that radial training is important to their institutions. And it's a good way to start a program off on the right foot."
Developed as a means of continuing access to radial education and physician experts, RAMP picks up where the SCAI's TRIP program leaves off. "TRIP provides an outstanding education to physicians interested in implementing radial, and then RAMP keeps the momentum going by offering on-site procedural training for a full hospital team," said Dr. Shroff. "This type of training improves the likelihood that physicians and cath lab staff will adopt the radial approach and maintain a radial practice."
Structured to maximize physician interaction, RAMP provides one day of didactic curriculum focusing on the basics of starting a transradial program combined with on-site proctorship during cases. These programs will provide a great opportunity for physicians to learn common technical aspects of the radial approach, particularly with regard to patient and lesion assessment and catheter selection. Learning from an expert in your home institution will provide just the right setting to gain full exposure to the opportunities and challenges with this approach.
More Information on SCAI's RAMP Program
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Don't Wait Any Longer! Enrollment for SCAI Fall Fellows Filling Quickly
Attention interventional cardiology fellows-in-training, training program directors and coordinators. Enrollment is filling quickly for SCAI 2012 Fall Fellows Courses in Adult Interventional Cardiology and Congenital & Structural Disease.
Featuring a streamlined schedule, an all-new location at The Cosmopolitan of Las Vegas, and a faculty of the biggest names in interventional cardiology, SCAI Fall Fellows is the must-attend meeting for fellows-in-training.
If you are serving in the fourth year of your interventional cardiology fellowship, or serving in the third or fourth year of your pediatric cardiology fellowship and interested in cardiovascular catheterization, you qualify to register for SCAI's Fall Fellows Course, which includes:
- FREE Tuition, Travel & Hotel (restrictions apply)
- WORLD CLASS FACULTY featuring the Best of the Best in Interventional Cardiology
- HANDS-ON simulation training
- UPDATES on the most widely used interventional procedures
Don't Wait! Applications for the Fall Fellows Scholarship are Due September 14
Download the Preliminary Program
Find Out About FREE SCAI Membership for Interventional FITs
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Learning Spotlight: SCAI-QIT Webinar Archives Focus on Job #1 - Quality
Quality is job #1 as the interventional cardiology community focuses on tackling continuous quality improvement in the cardiac cath lab by getting involved in SCAI's Quality Improvement Toolkit (SCAI-QIT).
SCAI-QIT's Library of Webinar Archives makes it even easier to focus on quality improvement, by providing cardiovascular professionals and interventional/invasive cardiologists with FREE, 24/7 access to several webinars focusing on guidelines, peer review conferences, random case selection, national database participation, pre-procedure checklists, data collection, inventory management, and more.
Here's what some webinar attendees have had to say about the series:
"Excellent webinars - like the links provided - easier to access when content fresh in mind- thank you!"
"Excellent source of useful information, Thank You!"
"Very Informative and put together very well"
"Great webinar. Look forward to sharing this information and implementing more Quality Improvement components."
Access the Archive of Past SCAI-QIT Webinars
Visit SCAI's eLearning Library