There are many ways of doing things in medicine, but once in a while you find a new way that appears to be a no-brainer because of its increased benefits, improvements to patient safety and the large amount of clinical data showing why it should become a standard of care. Radial access is certainly one of these areas where by simply changing where you access a patient's vasculature for interventional procedures, there appears to be a myriad of benefits gained at little to no additional cost. That is a win-win in today’s economic reality in healthcare.
Data suggests use of radial access may greatly reduce bleeding complications related to the access site, make hemostasis much easier, allow immediate patient ambulation following a procedure, cut nursing/recovery time and allow faster discharge of patients. This could have a major impact on the U.S. healthcare system, especially as patient volumes are expected to increase with an aging population. However, it is only used in about 25 percent of U.S. cath lab procedures.
Why Radial Access Has Low Usage in the U.S.
While it is easy to say just changing the arteriotomy site from the femoral artery in the groin to the radial artery in the wrist is a good thing, there are many factors that make it a great deal more complicated. The biggest obstacle really boils down to teaching old dogs new tricks. Cardiologists who have been performing procedures the same way they were trained in medical school, residency and fellowship programs do not want to deviate from what they are comfortable with. There is always the fear of the learning curve required to become proficient with a new technique and the question of what will happen if there is a complication the operator is not familiar with. There are now many transradial training programs, including those run by the Cardiovascular Research Foundation (CRF) and the Society for Cardiovascular Angiography and Interventions (SCAI).
Another factor may be patient volume. Overseas, radial access has a much higher usage rate, but this may be due to the fact that interventional cardiologists outside the United States generally have much higher patient volumes, especially in countries with socialized medicine or in places where the patient-to-doctor ratio is much higher than in the United States. This requires new ways to become more efficient, and radial access offers this opportunity.
Radial Access Can Save Money
Transradial access lowers bleeding complication rates, access closure is more reliable with pressure alone without the need for closure devices and earlier patient ambulation helps reduce the nursing time required per patient, said Adhir Shroff, M.D., MPH, assistant professor of medicine, director, cardiac cath lab, University of Illinois at Chicago (UIC). To demonstrate how this translates into savings and efficiency for hospitals, Shroff used the example of his own cath lab. The average time spent using radial for diagnostic caths is 54.6 minutes, as opposed to 72.5 for transfemoral. For PCI, transradial cases average 47.2 minutes, as opposed to 91.7 for femoral access. UIC performs about 2,000 PCIs annually, and if all were performed using radial, Shroff said it would save about 980 hours of time per year. At a cost of $48.40 per hour for use of the cath lab, the savings would be $50,000 per year.
UIC also found there was an average savings of $1,716 per case when radial was used (transfemoral cost about $12,714, radial about $10,997 at UIC). If all PCIs were performed by radial access, the savings would be about $3.4 million a year.
“I think that kind of savings by just changing the access site is really impressive,” Shroff said. “It’s a quick message that is easy to break down to show the benefits.”
The Medical University of South Carolina reduced its bleeding complication rate by 50 percent in the first year of its radial program in 2009. It also found radial helped reduce direct and indirect costs, and length of stay for a savings of $1,200 per patient. The Frederik Meijer Heart and Vascular Institute, Grand Rapids, Mich., found radial access resulted in a savings of about $1,900 per patient, partly due to reducing the length of stay.
Key Radial Access Information Sources on DAIC