Heart Care Plan Under Fire

WHEELING – West Virginia hospitals not already offering angioplasty to open a heart patient’s clogged arteries soon may be allowed to do so – without having a cardiac surgeon standing by in case things go wrong.

The West Virginia Health Care Authority on Wednesday approved cardiac catheterization standards based on pilot studies conducted at three hospitals in the state. The measure is expected to be considered for approval by Gov. Joe Manchin in the next 30 days. Hospitals first must apply for a certificate of need with the authority before being allowed to do the procedure.

The authority concluded that since there are only six providers of cardiac surgery in the state – Wheeling Hospital, Charleston Area Medical Center, St. Joseph’s Hospital, Monongalia General Hospital, West Virginia University and St. Mary’s Medical Center – that someone not near these facilities having a heart attack would instead go to another “community hospital” for help. Currently, to receive angioplasty, a patient presenting at a “community hospital” must first be transferred to a hospital that provides the procedure.

Angioplasty uses a balloon of sorts to open a blocked artery and can involve the insertion of a stent to keep the artery open, restoring blood flow.

“Since (angioplasty) is the best treatment available, it is important to make it more available in community hospitals where most of the patients are currently presenting for treatment,” according to the authority.

The “community hospitals” would not be required to also offer cardiac surgery services, which doctors at one local hospital said is a problem. During a news conference Thursday at Wheeling Hospital, interventional cardiologist Dr. Robert Fanning and cardiovascular surgeon Dr. Ahmad Rahbar said the health care authority’s recommendation to permit angioplasty without heart surgery services on site is not in the best interests of patients.

For example, if a “community hospital” without cardiac surgery services performs angioplasty on a person and there are complications – such as a laceration in an artery – that patient must be taken to another hospital that can perform open heart surgery.

This lapse in time, they noted, can be dangerous for the patient.

”The concern here is the safety of patients,” Rahbar said.

Also, to perform angioplasty well, hospitals must have a high volume of patients on whom to do the procedure.

If that volume is taken away, then hospitals already doing the procedure will have fewer chances to continue improving their methods. In other words, instead of having a hospital with excellent angioplasty standards, a community will have a few hospitals with mediocre angioplasty skills, the local physicians said.

”The Health Care Authority is not making it clear that volume of patients translates to quality of care,” Fanning said.

For example, Fanning said a large-volume institution is one that performs 400 or more procedures a year. Wheeling Hospital performed 574 in 2007.

“I think it was sold to the Health Care Authority that this is how we treat heart attacks, why shouldn’t everyone be doing it?” Fanning said.

During the authority’s comment period, Wheeling Hospital sent a letter expressing its concerns. In the letter, Chief Executive Officer Ronald Violi states that allowing community hospitals to offer angioplasty will lead to a lower standard of care for patients. He points out Ohio Valley Medical Center is only a few miles away from Wheeling Hospital, and allowing it to provide angioplasty “will not increase access for anyone.”

“It will only lead to higher cost, lower quality services at both providers,” Violi wrote.

OVMC spokeswoman Maggie Espina said Thursday that both OVMC in Wheeling and East Ohio Regional Hospital in Martins Ferry are pursuing plans to start offering angioplasty. She noted the West Virginia Health Care Authority’s recommendations are nothing new to health care. Other states have allowed hospitals to offer angioplasty without cardiac surgeons on site. And the pilot studies in West Virginia were successful, she said.

Espina said OVMC does not offer heart surgery services, but it does have other heart-related services such as catheterization, which is a procedure that involves using dye to look for blockages. However, the procedure does not remove blockages that are found.

If the hospital was offering angioplasty today and complications arose, open heart surgery could not be conducted there; the patient would have to be transferred to another hospital. However, it is not uncommon for hospitals to transfer patients to other hospitals for various procedures, she noted. Espina declined to say whether OVMC would invest in offering heart surgery services, but she said the hospital is “always exploring our options in providing services.”