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ICYMI: SCAI Efforts Result in Major Changes to ABIM MOC Policies
In case you missed it, the American Board of Internal Medicine (ABIM) announced significant and far-reaching changes to maintenance of certification policies. Subspecialists will no longer need to maintain certification in a foundational discipline to remain certified in a subspecialty, a change for which SCAI has lobbied ABIM over the past two years. This means that interventional cardiologists will not need to take general cardiology boards to recertify in interventional cardiology. These most recent changes will be fully implemented by Jan. 1. The Society recognizes that additional changes are needed, but is encouraged by the overall course of recent developments at the ABIM. SCAI will continue to work with ABIM while exploring multiple pathways to recertification options, to ensure our members have appropriate and suitable options for maintaining certification.
Read SCAI President Dr. James Blankenship's message on this development.
Related: ABIM to Eliminate Underlying Certification Requirement for 9 Subspecialties (Healio)
Related: ABIM Will Discontinue Requirement for Maintaining Underlying Board Certification for Interventional Cardiology and 14 Other Subspecialties (Cardiac Interventions Today)
Related: Easier MOC for Interventionalists (MedPage Today)
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CMS: Providers Can Expect Flexibility With ICD-10 Implementation
Centers for Medicare and Medicaid Services
This week, less than three months before the conversion from ICD-9 to ICD-10, the Centers for Medicare and Medicaid Services indicated that it will be somewhat flexible with implementation. Among other details, CMS announced that it will not deny claims because a procedure is billed with an imprecise diagnosis code as long as the provider uses a code from the right family.
For more details, visit the American Medical Association website and review CMS's announcement.
Join the Discussion on How to Use OCT to Guide Antegrade CTO
Emmanouil Brilakis, MD, PhD, FSCAI, of Dallas VA Medical Center and UT Southwestern Medical Center recently presented a case illustrating the use of OCT to guide antegrade dissection and re-entry during right coronary CTO PCI, sparking follow-up questions. Review and weigh in now!
The SCAI Imaging Center is developed and maintained with the generous support of St. Jude Medical. SCAI gratefully acknowledges this support while taking sole responsibility for all content developed and disseminated through this effort.
Poor Mobility Strongly Predicts Mortality in TAVR Patients
Poor mobility predicts worse short- and long-term survival in patients undergoing TAVR, according to a study published online last week, ahead of print in Catheterization and Cardiovascular Interventions. Hence, mobility screening should be performed before selecting patients for the procedure, researchers suggest "The clinical ramifications are significant, given that mobility assessment is a straightforward, cheap and quick measurement in the majority of cases, especially in relation to the multiple technical assessments that are required to identify suitable patients," writes David Hildick-Smith, MD, FSCAI, of the Brighton and Sussex University Hospitals NHS Trust (Brighton, England).
Older Age Tied to Higher Risk of Recurrent Cerebral Ischemia in PFO Closure Patients
Recurrent stroke and/or TIA after PFO closure is more common among older patients and is unrelated to residual shunt and paradoxical embolism, according to a study published in Catheterization and Cardiovascular Interventions. "The appropriate selection of candidates [for] closure and the monitoring of the progression of underlying vascular or arrhythmic disease are, therefore, crucial," write Paolo Scacciatella, MD, of Azienda Ospedaliera Universitaria Città della Salute e della Scienza (Turin, Italy), and colleagues. "Existing data support the safety of transcatheter PFO closure but are conflicting regarding its superiority [over] medical therapy, despite a tendency in favor of the interventional treatment that reached a significant difference only in patients with a severe shunt [or septal aneurysm] and when both strokes and TIAs were considered," the authors write, adding that most RCTs have focused on only a younger patient cohort. Sammy Elmariah, MD, MPH, of Massachusetts General Hospital (Boston, MA), said the results are not surprising and "lend further support to our belief that PFO closure is safe and that it is associated with incredibly low recurrent cerebrovascular events in well-selected patients."
Single-Center Study Adds Further Data to Debate Over PFO Closure
Percutaneous PFO closure following cryptogenic stroke or TIA appears effective and carries low risks of minor and major complications in the years after treatment, according to a retrospective study published online, ahead of print in Catheterization and Cardiovascular Interventions. "Our study demonstrates that percutaneous PFO closure in patients with presumed paradoxical embolism is safe and effective," write Mikaeil Mirzaali, BMBS, of Brighton and Sussex University Hospitals (Brighton, England), and colleagues. Although RESPECT, PC-Trial and CLOSURE I raised doubts about the efficacy of PFO closure for stroke protection compared with medical therapy, the study authors say their experience shows the procedure is safe and effective in the long term.
Another PFO Closure Study Yields Mixed Migraine Results
The latest study on PFO closure for treatment of refractory migraine failed to achieve its primary endpoint but still leaves the door open for potential efficacy in a subset of patients, researchers say. Final data from the Prospective, Randomized Investigation to Evaluate Incidence of Headache Reduction in Subjects With Migraine and PFO Using the AMPLATZER PFO Occluder to Medical Management were presented at the American Headache Society 57th Annual Scientific Meeting. "While PFO closure was not effective in the overall population, the study may have identified a subgroup of patients in whom the procedure is very effective," said SCAI President James Blankenship, MD, MHCM, FSCAI. The difficulty ahead, in his view, is to identify the patients who may benefit from PFO closure and those who will not benefit, and treat each group appropriately.
Survival Benefit of CoreValve in High-Risk Patients Persists at 2 Years
In patients with severe aortic stenosis who are at increased surgical risk, the survival advantage of TAVR using a self-expanding bioprosthesis over surgery seen after one year is sustained at two years, according to follow-up from the CoreValve U.S. Pivotal Trial published in the July 14 issue of the Journal of the American College of Cardiology.
'Breakthrough' Heart Failure Drug Wins Speedy Approval
The first drug to demonstrate a mortality benefit when compared with enalapril for heart failure — Entresto (sacubitril/valsartan), previously known as LCZ696 — received Food and Drug Administration approval.
The drug, developed by Novartis, has been hailed as a game changer by cardiologists who have previously been frustrated by disappointing results for other drugs for this condition.
Medicare Proposes Coverage Change to 2-Midnight Rule
The Associated Press via The Washington Post
Medicare has proposed to ease the "two-midnight rule" — the coverage policy on short hospital stays that has been criticized because it can result in higher costs for seniors. Under Medicare, coverage for inpatient and outpatient care is determined under very different payment rules. The new proposal would allow for case-by-case exceptions. Based on a doctor’s judgment, certain short hospital stays could be covered under inpatient payment rules.
Many Patients Report Suboptimal Adherence to Medications After Acute MI
As early as six weeks after acute MI, nearly 30 percent of patients report moderate or low adherence to medications, which is potentially linked to increased risk for death or readmission, according to new findings. "Tailored patient education and predischarge planning, as well as the availability of continued patient interactions with the health system early after hospital discharge, may represent key actionable opportunities to optimize patient adherence and improve outcomes," Robin Mathews, MD, and colleagues wrote in Circulation: Cardiovascular Quality and Outcomes.
Related: A Call to Action: Strategies to Improve Adherence to Dual Antiplatelet Therapy Following Percutaneous Coronary Intervention (Healio)
Cardiovascular Risk Factors Are High Throughout the US
A study published in Annals of Internal Medicine on June 30 found at least three-quarters of people in each state had at least one cardiovascular risk factor.
The researchers analyzed two national data sets and found half of cardiovascular deaths in the U.S. in 2009 and 2010 were attributed to five common risk factors: elevated cholesterol, diabetes, hypertension, obesity and smoking. Lead author Shivani A. Patel, PhD, told Cardiovascular Business the results did not surprise her, but she did not anticipate that 81.7 percent of men and 80.0 percent of women had at least one cardiovascular risk factor.
Fast Call IDs Zebras vs. Horses in ER
The implementation of a stroke alert plan at a large, referral hospital pediatric emergency department resulted in rapid identification of stroke and other serious neurological emergencies in children treated in the emergency department, researchers reported.
Evaluation by a neurologist within 15 minutes of the stroke alert notification and the availability of urgent magnetic resonance imaging were key elements of the plan adopted at the Monroe Carell Jr. Children's Hospital at Vanderbilt in Nashville, Tennessee.
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