Nav: Home

National hospital system uses enterprise approach for assessing bleeding risks

May 04, 2016

Orlando, Fla. - The largest risk-directed study by a national hospital system demonstrates a 40 percent decline in bleeding events for percutaneous coronary intervention (PCI) patients and a significant reduction in pharmacy costs. This quality improvement project (QIP) study was presented today as a late-breaking clinical trial at the Society for Cardiovascular Angiography and Interventions (SCAI) 2016 Scientific Sessions in Orlando, Fla.

PCI opens narrow or blocked coronary arteries. While it is a common non-surgical procedure, PCI-related bleeding can result in substantial morbidity and mortality. The QIP study aimed to reduce these bleeding events by using the National Cardiovascular Data Registry (NCDR) bleeding risk calculator and applying it to evidence-based bleeding avoidance strategies, including bivalirudin use.

"We found that some centers were using bivalirudin 100 percent of the time and others were not using it at all," said Jerome E. Granato, MD, vice president and medical director, National Cardiovascular Service Line at Catholic Health Initiatives, and the study's lead author. "Our goal was to determine the most appropriate time to use bivalirudin, which is why the bleeding risk calculator was so vital."

The two-year study (2013-2015) involved 8,713 PCI procedures from 21 hospitals, in 11 states, with more than 200 operators. The baseline Q1 2013 risk-adjusted bleeding event rate was 6.3 percent. Researchers used the bleeding risk calculator (Q2 2014) during the intra-procedural "time-out" and, based on the score, divided patients into high, intermediate or low bleeding risk groups. Depending on the risk assessment, access site and anticoagulant use, other interventions were used at the discretion of the operator.

Over the two-year period, incidence of bleeding decreased by 40 percent (6.3 percent to 3.78 percent). In addition, the cost of bleeding complications -- typically about $8,000 per patient -- was reduced by approximately $1 million for the entire hospital system.

Further, data showed that when physicians conducted the bleeding risk assessment before the procedure, they not only changed the use of the drug, they also adjusted their approach, going through the wrist instead of the groin with high-risk patients.

Researchers monitored compliance by recording patients who received bivalirudin, their risk calculator scores and the percentage who fell into each risk category. That information was relayed back to the hospitals and resulted in greater adherence to the process.

"Our results showed that in a very large patient population and an expansive health system, we were able to change behaviors that resulted in better patient care and significant financial savings," noted Dr. Granato. "We believe this process could easily be adopted by other health systems."
-end-
The authors reported no disclosures. Catholic Health Initiatives has received an unrestricted educational grant from the Medicines Company.

Dr. Granato presented "Risk Directed Interventions in Percutaneous Coronary Intervention (PCI): An Enterprise Approach for Reducing Bleeding Events" on Wednesday, May 4, 2016 at 1:45 pm ET.

For more information about the SCAI 2016 Scientific Sessions, visit http://www. SCAI.org/SCAI2016.



About SCAI


The Society for Cardiovascular Angiography and Interventions is a 4,500-member professional organization representing invasive and interventional cardiologists in approximately 70 nations. SCAI's mission is to promote excellence in invasive/interventional cardiovascular medicine through physician education and representation, and advancement of quality standards to enhance patient care. SCAI's public education program, Seconds Count, offers comprehensive information about cardiovascular disease. For more information about SCAI and Seconds Count, visit http://www.SCAI.org or http://www.SecondsCount.org. Follow @SCAI on Twitter for the latest heart health news.

Society for Cardiovascular Angiography and Interventions

Related Bivalirudin Articles:

No difference in rate of adverse cardiovascular events when comparing anticoagulants
In patients undergoing transradial primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI), there was no significant difference in the rate of a composite of death, myocardial infarction and stroke whether they were anticoagulated with bivalirudin or unfractioned heparin, according to a study today in JACC: Cardiovascular Interventions.
Analysis looks at role type of valve plays in patient outcomes post-TAVR
Results from 'Impact of valve design and bivalirudin vs. unfractionated heparin for anticoagulation in transcatheter aortic valve replacement: Results from the BRAVO-3 trial' were presented today as a late-breaking clinical trial at the Society for Cardiovascular Angiography and Interventions (SCAI) 2017 Scientific Sessions in New Orleans.
Analysis shows increased risk of early stroke with new-onset atrial fibrillation post-TAVR
Results from 'Effect of bivalirudin versus unfractionated heparin in patients with baseline or new-onset atrial fibrillation in transcatheter aortic valve replacement: From the BRAVO-3 randomized trial' were presented today as a late-breaking clinical trial at the Society for Cardiovascular Angiography and Interventions (SCAI) 2017 Scientific Sessions in New Orleans.
Two differing medications used during heart procedure are both safe and effective, study finds
Two differing blood clot prevention medications are just as safe and effective for patients undergoing percutaneous coronary intervention, a non-surgical procedure to open blood vessels narrowed by plaque buildup, according to a new study.
Smoking rises in Argentina heart attack patients as cigarettes 'among cheapest in world'
Levels of smoking are rising in heart attack patients in Argentina, according to a study presented today at the Argentine Congress of Cardiology (SAC 2016).
Anticoagulation medications show no gender-based variations in outcomes for TAVR patients
A study on the impact of using different anticoagulation medications on men and women who have undergone a transcatheter aortic valve replacement (TAVR) found no difference in early vascular complications or mortality.
National hospital system uses enterprise approach for assessing bleeding risks
The largest risk-directed study by a national hospital system demonstrates a 40 percent decline in bleeding events for percutaneous coronary intervention (PCI) patients and a significant reduction in pharmacy costs.
Reasons for hospital-level variations in bleeding post-angioplasty are unclear
The use of bleeding avoidance strategies has only a modest effect on the variation in bleeding rates post-angioplasty among hospitals performing this procedure, leaving about 70 percent of the causes for this variation unexplained, according to a study published today in JACC: Cardiovascular Interventions.
Antiplatelet therapy with blood thinners reduces mortality for angioplasty patients
Patients with acute coronary syndrome who have undergone angioplasty have a reduced risk of all-cause in-hospital mortality but an increased risk of bleeding when given glycoprotein 2b/3a inhibitors after the procedure, according to a study published today in JACC: Cardiovascular Interventions.
CRF announces press conference schedule for TCT 2015
The Cardiovascular Research Foundation has announced the press conference schedule for late-breaking trials and first report investigations that will be presented at the Transcatheter Cardiovascular Therapeutics 2015 scientific symposium.

Related Bivalirudin Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Jumpstarting Creativity
Our greatest breakthroughs and triumphs have one thing in common: creativity. But how do you ignite it? And how do you rekindle it? This hour, TED speakers explore ideas on jumpstarting creativity. Guests include economist Tim Harford, producer Helen Marriage, artificial intelligence researcher Steve Engels, and behavioral scientist Marily Oppezzo.
Now Playing: Science for the People

#524 The Human Network
What does a network of humans look like and how does it work? How does information spread? How do decisions and opinions spread? What gets distorted as it moves through the network and why? This week we dig into the ins and outs of human networks with Matthew Jackson, Professor of Economics at Stanford University and author of the book "The Human Network: How Your Social Position Determines Your Power, Beliefs, and Behaviours".