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SCAI Statement on MEDCAC Lower Extremity PAD Panel
Yesterday, the Centers for Medicare & Medicaid Services (CMS) convened a panel of the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) to review scientific evidence on interventions aimed at improving care for Medicare patients with lower extremity peripheral artery disease (PAD). The panel discussed care for patients with three levels of disease progression: asymptomatic, intermittent claudication, and critical limb ischemia (CLI). The panel vote reflects the value of PAD interventions on patient outcomes, even though long-term data is not yet available in this relatively young field of healthcare. The panel voted with an intermediate level of confidence that there is sufficient evidence interventional therapies in asymptomatic patients result in long-term health outcomes. The panel also voted with an intermediate level of confidence there is sufficient evidence that CLI improves immediate health outcomes, as well as long-term health outcomes.
"The data are clear: Lower extremity revascularization saves limbs and changes lives dramatically," said Kenneth Rosenfield, MD, MHCDS, MSCAI, section head for the Vascular Medicine and Interventional Division of Cardiology at Massachusetts General Hospital, and president-elect of SCAI. "The issue is which revascularization procedures are optimal across a range of conditions. Until the research is more definitive, it's essential we preserve the physician's freedom to recommend the best treatment for his or her patients."
"There was agreement on the panel that even as we await critically needed data on PAD treatments, it would be unconscionable to not treat these patients, especially when limbs are at stake," said Dr. Rosenfield.
Read the full SCAI statement on the MEDCAC Panel vote.
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SCAI FIT Portal: At the Core of Interventional Cardiology Training
As interventional cardiology fellows-in-training (FITs) begin their formal training through the U.S., it's time to turn to the SCAI FIT Portal, the single online source solely devoted to the educational, developmental and career needs of interventional/invasive cardiology fellows-in-training (FITs) and their program directors.
Part of the Society's continuing effort to to lead the way in providing high-quality resources for interventional/invasive FITs, the SCAI FIT Portal will allow fellows to navigate all-new educational content while allowing Program Directors to monitor their fellows' progress.
Access the FIT Portal now
- SCAI's Web-based procedure log is easy to use with all information stored in one location to allow for easy assessment of procedural skills learned during training.
- Online education through the portal's Core Curriculum
- Courses are aligned with ABIM/ACGME standards
- Augmentation of fellowship training and help with board prep
- Program directors can assign lectures and monitor fellows' progress.
- The educational offerings will be continuously refreshed with content presented by top experts in the field.
- Ability for program directors and program coordinators to print progress reports on courses assigned to their fellows
SCAI offers free membership to interventional fellows-in-training
SCAI gratefully acknowledges the following companies for their generous support of the SCAI FIT Portal while taking sole responsibility for all content developed and disseminated through this event.
- Abbott Vascular
- Boston Scientific
Now Accepting SCAI Helping Hearts Lifetime Service Award Nominations
SCAI is calling for nominations for the SCAI Helping Hearts Lifetime Service Award. Introduced in 2015, this award recognizes members who have provided outstanding service to SCAI over their lifetime. Inaugural awardees were Joseph D. Babb, MD, MSCAI, and Harry L. Page Jr., MD, FSCAI. Award recipients recognized by their peers have demonstrated substantial and consistent service to the Society for over 25 years as SCAI members, having:
Learn more and submit your nomination by the Oct. 31 deadline.
- Provided a moral and ethical example for others;
- Striven for excellence in patient care; and
- Dedicated themselves to the highest professional standards.
SCAI President Weighs in on TCTMD Series Exploring Excess Readmissions
With the advent of the Affordable Care Act and public reporting of readmission rates by the Centers for Medicare and Medicaid Services, healthcare professionals and researchers are looking more closely at how to prevent patients from unnecessarily returning to the hospital after their initial discharge. In a two-part series, TCTMD is exploring excess readmissions and what can be done about them. SCAI President James Blankenship, MD, FSCAI, weighs in on the issue pointing out there is a weak link between PCI quality and readmission rates which has been underlined by findings from several studies.
DES, BMS Both Suitable for Treating Patients With SVG
For older patients with failing saphenous vein grafts, DES are as protective as BMS against MI and urgent revascularization at three years and offer lower long-term mortality, according to an observational study published online ahead of print in Catheterization and Cardiovascular Interventions. As such, "DES use appears to be safe for SVG PCI," J. Matthew Brennan, MD, MPH, of Duke University Medical Center (Durham, NC), and colleagues say. The researchers combined Medicare records with data from the National Cardiovascular Data Registry CathPCI Registry to create longitudinal records for 49,325 patients at least 65 years old who underwent stenting with BMS or DES for SVG failure at 1,001 sites from 2005 through 2009. Procedural success was similar regardless of stent type, but periprocedural complications — including in-hospital death, MI, cardiogenic shock, and new heart failure symptoms — occurred more often in patients who received BMS than DES. By three years, DES patients required more urgent revascularization but were less likely to die than those treated with BMS, and MI rates were equivalent between the two groups.
Inappropriate Cath, Appropriate Revascularization
In his monthly Practitioner's Corner blog on theheart.org on Medscape Seth Bilazarian, MD, FSCAI, details the phenomenon of ICAR in Appropriate Use Criteria (AUC) and offers helpful advice to both practitioners as well as future AUC writing groups. In his blog he details two cases of ICAR — an inappropriate cath, appropriate revascularization and also encourages colleagues to employ the SCAI-QIT AUC App in their cath labs.
Endovascular-1st Approach Reduced Major Amputations for Patients With Critical Limb Ischemia
For patients presenting with critical limb ischemia at a single center in Australia, the shift to an endovascular-first revascularization strategy reduced the rate of major amputations and the length of hospital stay.
Researchers evaluated revascularization strategies during an eight-year period for 279 patients undergoing treatment for critical limb ischemia (344 critically ischemic limbs) during 546 hospital admissions. Changes to staff at Prince of Wales Hospital in Sydney in 2008 resulted in "a paradigm shift toward the unit approaching critical limb ischemia with a primary 'endovascular-first' strategy after that time," Nedal Katib, MB BCh, BAO, and colleagues wrote in the Journal of Endovascular Therapy.
Zero CAC Score Confers 15-year 'Warranty' Against CAD
A coronary artery calcium score of zero confers at least a 15-year "warranty" during which mortality risk from coronary artery disease remains under 1 percent in both men and women, a long-term prospective follow-up study indicates.
No Excess Mortality When PCI Performed at Centers Without On-site Surgery
Mortality rates are similar regardless of whether patients undergo PCI at centers with or without on-site surgical support, according to observational data from Wales and England published in the July 28 issue of the Journal of the American College of Cardiology. However, it remains to be seen whether PCI with on-site surgery may be superior for certain patient subsets, lead author Scot Garg, MBCHB, PhD, of East Lancashire Hospitals NHS Trust, told TCTMD in a telephone interview.
MVARC Document Offers Template for Mitral Valve Therapeutics Research
A group of 44 international experts across numerous specialties has released guidance aimed at easing and standardizing the study of new transcatheter mitral valve therapies, particularly those targeting mitral regurgitation. In two separate papers published in the July 21 issue of the Journal of the American College of Cardiology, members of the Mitral Valve Academic Research Consortium delve into clinical trial design and provide consensus definitions needed to establish consistency across studies.
Doctors Pay Resumes Upward March After Prior Year's Slowdown
Cardiologist Dr. Edward Fry recalls making one-sixth as much as top earners in his field when he began practicing medicine in 1990.
Today, he says, beginning cardiologists typically start out earning as much as two-thirds the salary of a full partner at his practice, which is a part of Ascension Health.
Heart Procedures Don't Seem to Up Cognitive Risk in Elderly
There was little risk of long-term cognitive decline related to cardiac procedures among elderly patients, according to a literature review, but the data were limited and better studies are needed to assess the risk, researchers said. Based on independent rating of quality and strength of the evidence of 17 randomized trials and four cohort studies, there was no difference in cognitive function among patients treated with on- and off-pump coronary artery bypass graft, and no difference in function between patients treated with hypothermic and normothermic CABG, reported Howard A. Fink, MD, MPH, of the Minneapolis Veterans Affairs Health Care System, and colleagues.
Aspirin Use for Prevention of Recurrent Atherosclerotic CVD Varies in US
Geographic and sociodemographic disparities in aspirin use as a secondary prevention for MI and stroke were observed among patients with preexisting atherosclerotic cardiovascular disease, according to a recent Centers for Disease Control and Prevention report. "The use of this low-cost, effective and generally safe intervention among persons who have existing atherosclerotic cardiovascular disease is supported by multiple evidence-based guidelines, and current data suggest that there is room for increased use in this population," Jing Fang, MD, from the division for heart disease and stroke prevention at the CDC's National Center for Chronic Disease Prevention and Health Promotion, and colleagues wrote in the Morbidity and Mortality Weekly Report.
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||SCAI Fellows Course at LWSIC
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