Report of interventional cardiology practice presented in first extensive survey
A report on interventional cardiology practice from an extensive survey is presented today at EuroPCR 2018, the annual meeting of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), a branch of the European Society of Cardiology (ESC).
The EAPCI White Book is the first systematic data collection on the practice of interventional cardiology, a branch of cardiology which delivers catheter-based (percutaneous) treatment of heart diseases—for example inserting stents to open clogged arteries (called percutaneous coronary intervention, or PCI).
A wide spectrum of resource allocation and treatment implementation was reported by countries participating in the 2016 survey. Hospitals equipped with catheterisation laboratories (the operating rooms for catheter-based procedures) ranged from less than 2 to more than 5 per million people. Likewise the number of interventional cardiologists ranged from 10 to more than 25 per million people.
Clinical evidence supports the performance of percutaneous coronary intervention (PCI) by inserting the catheter via the radial artery in the wrist and using drug-eluting stents where indicated. The survey found that more than half of PCIs were performed via the radial artery and drug-eluting stents were frequently used (more than 3,000 cases per million inhabitants) in most of the participating countries. Yet the survey highlighted a low penetration rate of drug-eluting stents in a few countries, suggesting that there are barriers to implementing this effective treatment.
Primary PCI, an urgent first treatment to open clogged arteries (rather than clot-busting drugs) is recommended by ESC guidelines for treatment of patients suffering a heart attack.2 Most countries participating in the survey were delivering at least 500 primary PCIs per million inhabitants, the level promoted by Stent—Save a Life!, the EAPCI's primary PCI implementation programme.
The survey shows that transcatheter aortic valve implantation (TAVI) and other percutaneous structural heart interventions are becoming increasingly popular. However, the implementation of this therapy is not uniform among the participating countries due to different reimbursement policies.
The survey covers all aspects of interventional cardiology including organisational models, numbers of procedures, resource allocation, and training. The 16 countries participating in the 2016 survey were Belgium, Denmark, Egypt, France, Germany, Greece, Italy, the Netherlands, Poland, Romania, Slovenia, Spain, Sweden, Switzerland, Turkey, and the UK. Future editions will include more ESC member countries.
Professor Emanuele Barbato, lead author, said: "The EAPCI White Book is a valuable resource for monitoring the implementation of guideline recommendations in clinical practice. Healthcare payers and regulatory bodies can use it to compare the allocation of resources to interventional cardiology in Europe. The reported trends in practice will enable industry bodies to target investment to clinical needs."
The data were collected by interventional cardiologists in national cardiac societies and working groups under the leadership of Professor Michael Haude, EAPCI President, in collaboration with the ESC Atlas of Cardiology, a compendium of cardiovascular statistics from the 56 ESC member countries.3
Professor Panos Vardas, senior author of the Atlas and ESC Past President (2012—2016) said: "The EAPCI White Book is an important companion to the ESC Atlas of Cardiology, providing more in-depth information on this rapidly growing domain in cardiology."
2. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2018;39:119–177.
3. Atlas Writing Group, Timmis A, Townsend N, Gale C, Grobbee R, Maniadakis N, Flather M, Wilkins E, Wright L, Vos R, Bax J, Blum M, Pinto F, Vardas P. European Society of Cardiology: Cardiovascular Disease Statistics 2017. Eur Heart J. 2018;39:508–579.