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REDUCING BLEEDING COMPLICATIONS IN THE CATHLAB: A PATIENT-CENTERED APPROACH
84 JACC April 5, 2016 Volume 67, Issue 13
ACC.i2 Interventional Cardiology REDUCING BLEEDING COMPLICATIONS IN THE CATHLAB: A PATIENT-CENTERED APPROACH Poster Contributions Poster Area, South Hall A1 Saturday, April 02, 2016, 10:00 a.m.-10:45 a.m. Session Title: ACC.i2 Interventional Cardiology: Vascular Access and Complications Abstract Category: 12. ACC.i2 Interventional Cardiology: Vascular Access and Complications Presentation Number: 1106-184 Authors: Amit P. Amin, Mary Caruso, Pedro Calderon Artero, Samantha Miller, Jasvindar Singh, Howard Kurz, Patti Crimmins, Washington University in St. Louis, St. Louis, MO, USA, Barnes Jewish Hospital, St. Louis, MO, USA Background: Bleeding is a devastating complication of PCI. Though it is predictable and modifiable, bleeding avoidance therapies (BATs) such as radial access, closure devices or bivalirudin are used inconsistently in high risk patients (the risk-treatment paradox). Whether a patient centered approach is associated with reversal of the risk-treatment paradox and reduced bleeding is unknown.
Methods: From July 2013 to March 2015, we implemented a patient-centered, nurse-led approach at Barnes Jewish Hospital, St.Louis MO, via a health IT software to translate the NCDR bleeding risk model pre-procedure, and generate a decision aid to inform physicians of a patient’s bleeding risk. Monthly audit and feedback was conducted. We compared bleeding rates and BAT use over time using a quasiexperimental design. Results: Among 2,038 PCIs, 433 (21.5%) were at low, 1,055 (52.3%) moderate and 530 (26.3%) high risk for bleeding. BATs use increased over time, with the fastest uptake in radial access and reversal of risk-treatment paradox. Use of 1 or more bleeding avoidance therapies in the moderate or high risk group was strongly associated with reduced bleeding (OR 0.42, p < 0.001, 95% CI 0.26- 0.66). Bleeding rates rapidly declined over time (Fig). Conclusions: We have described a unique patient-centered approach implemented in the routine flow of care in the cathlab to achieve a rapid reduction in bleeding. Risk-aligned use of BATs and reversing the ‘risk-treatment paradox’ was associated with reduced bleeding.
ACC.i2 Interventional Cardiology REDUCING BLEEDING COMPLICATIONS IN THE CATHLAB: A PATIENT-CENTERED APPROACH Poster Contributions Poster Area, South Hall A1 Saturday, April 02, 2016, 10:00 a.m.-10:45 a.m. Session Title: ACC.i2 Interventional Cardiology: Vascular Access and Complications Abstract Category: 12. ACC.i2 Interventional Cardiology: Vascular Access and Complications Presentation Number: 1106-184 Authors: Amit P. Amin, Mary Caruso, Pedro Calderon Artero, Samantha Miller, Jasvindar Singh, Howard Kurz, Patti Crimmins, Washington University in St. Louis, St. Louis, MO, USA, Barnes Jewish Hospital, St. Louis, MO, USA Background: Bleeding is a devastating complication of PCI. Though it is predictable and modifiable, bleeding avoidance therapies (BATs) such as radial access, closure devices or bivalirudin are used inconsistently in high risk patients (the risk-treatment paradox). Whether a patient centered approach is associated with reversal of the risk-treatment paradox and reduced bleeding is unknown.
Methods: From July 2013 to March 2015, we implemented a patient-centered, nurse-led approach at Barnes Jewish Hospital, St.Louis MO, via a health IT software to translate the NCDR bleeding risk model pre-procedure, and generate a decision aid to inform physicians of a patient’s bleeding risk. Monthly audit and feedback was conducted. We compared bleeding rates and BAT use over time using a quasiexperimental design. Results: Among 2,038 PCIs, 433 (21.5%) were at low, 1,055 (52.3%) moderate and 530 (26.3%) high risk for bleeding. BATs use increased over time, with the fastest uptake in radial access and reversal of risk-treatment paradox. Use of 1 or more bleeding avoidance therapies in the moderate or high risk group was strongly associated with reduced bleeding (OR 0.42, p < 0.001, 95% CI 0.26- 0.66). Bleeding rates rapidly declined over time (Fig). Conclusions: We have described a unique patient-centered approach implemented in the routine flow of care in the cathlab to achieve a rapid reduction in bleeding. Risk-aligned use of BATs and reversing the ‘risk-treatment paradox’ was associated with reduced bleeding.