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Wrist or groin? Kudos to release on angioplasty routes for paying close attention to costs

Study Reveals Ways to Improve Outcomes, Reduce Costs for Common Heart Procedure

Our Review Summary

This release summarizes a study that showed using the wrist as opposed to the groin during coronary angioplasty, and allowing patients to go home on the day of the procedure rather than keeping them overnight, could result in substantial cost savings and reduced complications.

The study was based on data from 280,000 Medicare patients who underwent coronary angioplasty, also called percutaneous coronary interventions or PCI, to alleviate chest pain or shortness of breath. PCI involves using a balloon to open up clogged arteries and restore blood flow to the heart. Cardiologists frequently use the femoral artery in the groin as the access point when performing a PCI but researchers say here that entering via an artery in the wrist is the best method because it offers fewer complications and shorter hospital stays — which translate into cost savings.

The release does a good job of showing cost comparisons, but it’s based on extrapolation of a small percentage (9%) of Medicare patients that underwent PCI using the wrist entrance method.

We commend the release for adding extensive end notes about funding sources and financial disclosures. This is what we’d like to see in all news releases.

 

Why This Matters

Coronary angioplasty procedures are performed on some 600,000 patients each year, according to the researchers who conducted this study. Finding ways to reduce costs without sacrificing patient outcomes is critical for the American health care system.

Criteria

Does the news release adequately discuss the costs of the intervention?

Satisfactory

Cost comparison across angioplasty strategies is the raison d’etre of this study and its accompanying news release.  The release reflects on costs for both the individual procedure and for the country in great detail.

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The main benefit discussed here was the cost savings since that was the focus of the study. But what are the tangible benefits to patients who might be facing this procedure? The claims made are backed up by estimates of the cost savings based on the 9% of PCI patients that had the procedure using the wrist method. The first author of the study mentions reduced bleeding and fewer complications from angioplasty procedures that use the wrist artery and discharge patients on the same day, but it doesn’t provide any numbers for a reference point.

The published report stated that bleeding at the arterial site, the most common problem examined, occurred in 1.4% of patients receiving the lower cost wrist procedure and in 3% of those receiving the traditional groin entrance procedure (use of the femoral artery and at least one overnight hospital stay). While the complication rates are pretty low in both procedures, it’s something that could have been better explained in the release.

Does the news release adequately explain/quantify the harms of the intervention?

Not Satisfactory

The news release does not discuss any possible downsides associated with the new technique. Although the disadvantages of using the wrist rather than the groin approach are minor and perhaps not clinically relevant for most people, it would have been better for the release to at least mention them.

Does the news release seem to grasp the quality of the evidence?

Not Satisfactory

The release does an adequate job of explaining how the costs savings were calculated and how researchers gathered their data for the analysis. It states:

“The analysis demonstrated an average cost of $13,389 for the wrist approach with same-day discharge, compared with $17,076 for the groin approach with at least one night of hospitalization, resulting in a cost savings of about $3,700 for outpatients who get the wrist-access procedure. Independent of the length of stay, the wrist approach costs about $900 less than the groin approach, on average.”

However, this was an observational study, which has important limitations. The researchers discussed this in the study, and the release should have included it, too.

From the study: “First, the observational nature of these data may be subject to selection bias and unmeasured confounding, despite rigorous exclusions and propensity score methods with IPW to adjust for confounding associated with TRI use and SDD. Propensity score methods do not account for unmeasured confounding or selection bias (45–47).”

Does the news release commit disease-mongering?

Satisfactory

The release doesn’t engage in disease mongering. It provides strong context on what coronary angioplasty is, how many are performed annually, average costs and projects cost savings.

Does the news release identify funding sources & disclose conflicts of interest?

Satisfactory

The release is to be commended here for how it discloses funding sources and potential conflicts of interest. It includes these disclosures in an end note which doesn’t interfere with the flow of the release. This is what we’d like to see in all news releases.

Does the news release compare the new approach with existing alternatives?

Satisfactory

The point of the study was to compare variants on angioplasty method, and the release does that clearly.

Does the news release establish the availability of the treatment/test/product/procedure?

Satisfactory

It clearly conveys that the lower cost variants of angioplasty—use of the wrist artery and same-day discharge of the patient—are available but little utilized among Medicare patients. The use of the wrist entrance method appears very low (9%) among Medicare patients.

Does the news release establish the true novelty of the approach?

Not Satisfactory

The idea of going through the wrist is not novel. In fact, the main author published a very similar paper in 2013  and others have done similar work.

There is a large body of evidence on this issue and the news release could have acknowledged that.

Does the news release include unjustifiable, sensational language, including in the quotes of researchers?

Satisfactory

The first author of the research report is quoted as describing the evidence of this study as “unequivocal,” which is a bit strong, but the language in the rest of the release is straightforward.

Total Score: 6 of 10 Satisfactory

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