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Validated pre-procedure risk score reduces bleeding complications and can shorten stays

11.03.2013
Accurate identification of high-risk patients enables selective use of strategies to improve patient outcomes

A clinical decision support tool helped physicians identify patients at high risk of bleeding complications prior to undergoing a coronary intervention procedure and helped guide the use of bleeding avoidance strategies, leading to less complications and a shorter hospital stay, according to a study being presented March 10 at the American College of Cardiology Scientific Sessions.

More than 1.3 million percutaneous coronary interventions (PCIs) are performed each year in the United States. Bleeding during and after these procedures is a common risk (3 – 6%).

"Bleeding complications after PCI can lead to worse outcomes for the patient, including death, as well as an increase in the length of stay in the hospital, which leads to an increase in hospital costs," says the study's lead author Craig E. Strauss, MD, MPH, a research cardiologist at the Minneapolis Heart Institute Foundation and physician at the Minneapolis Heart Institute® at Abbott Northwestern Hospital in Minneapolis.

Therefore, the cardiologists across the Allina Health System used a validated pre-PCI bleeding risk score to accurately identify high-risk patients, allowing them to employ strategies to avoid bleeding and improve patient outcomes. Among those strategies, bivalirudin (Angiomax, The Medicines Company) is a direct thrombin inhibitor that has been shown to reduce bleeding complications in PCI.

"This risk-stratification tool can be used real-time in the cath lab to identify and mitigate a patient's risk for bleeding around the time of the procedure," says Strauss. "The cath lab team uses a web-based calculator, which takes less than 1-2 minutes, and determines the risk category of each patient." Due to the ease of use, the tool achieved a high adoption rate of 92 percent at three high-volume PCI centers in Minnesota.

Among the 2,608 PCI cases performed at the three PCI centers, 24.4 percent of the patients were identified as high risk for bleeding complications. The use of bivalirudin as a bleeding avoidance strategy in high-risk patients increased from 24.2 percent pre-implementation of the risk-stratification protocol to 60.3 percent after the implementation of the protocol.

Among high bleeding risk patients, the researchers reported significant reductions in overall complications (22.8% vs. 14.9%), bleeding events within 72 hours (7.7% vs. 2.1%), and median length of hospital stay (2.9 vs. 2.3 days) following protocol implementation. There also was a reduction in the use of blood transfusions and death. Finally, the total variable costs decreased from approximately $15,000 to $14,200.

"This clinical decision support tool helps cardiologists objectively validate which patients are at high risk for bleeding complications based on existing evidence," Strauss says. "Previously, we could attempt to identify which patients were at risk based on clinical intuition, but this tool gives a much more accurate assessment, as shown through the improved patient outcomes. Furthermore, this tool can help reduce the variability in practice patterns among physicians that can be costly to the healthcare system."

About the Minneapolis Heart Institute Foundation

The Minneapolis Heart Institute Foundation is dedicated to creating a world without heart disease through groundbreaking clinical research and innovative education programs. MHIF's mission is to promote and improve cardiovascular health, quality of life and longevity for all.

Scientific Innovation and Research – Publishing more than 120 peer-reviewed studies each year, MHIF is a recognized research leader in the broadest range of cardiovascular medicine. Each year, cardiologists and hospitals around the world adopt MHIF protocols to save lives and improve patient care.

Education and Outreach – Research shows that modifying specific health behaviors can significantly reduce the risk of developing heart disease. Through community programs, screenings and presentations, MHIF educates people of all walks of life about heart health. The goal of the Foundation's community outreach is to increase personal awareness of risk factors and provide the tools necessary to help people pursue heart- healthy lifestyles.

About the Minneapolis Heart Institute®

The Minneapolis Heart Institute® is recognized internationally as one of the world's leading providers of heart and vascular care. This state-of-the-art facility combines the finest in personalized patient care with sophisticated technology in a unique, family-oriented environment. The Institute's programs, a number of which are conducted in conjunction with Abbott Northwestern Hospital, address the full range of heart and vascular health needs: prevention, diagnosis, treatment and rehabilitation.

Steve Goodyear | EurekAlert!
Further information:
http://www.mplsheart.org/

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