Mauro Moscucci, M.D., M.B.A., professor and vice chair of medicine and chief of the Cardiovascular Division, has published a in the July 11 issue of the Archives of Internal Medicine. He was invited to write the commentary about a study in the same issue titled “Not All U.S. Hospitals Are Following Guidelines for Percutaneous Revascularization Procedures for Some Patients With an Occluded Artery Following a Heart Attack.”
A previous 2006 study known as the Occluded Artery Trial demonstrated no benefit to performing routine percutaneous coronary intervention (PCI) in patients with totally occluded arteries identified more than 24 hours after a myocardial infarction. The Occluded Artery Trial was classified as a medical “reversal trial,” one that was superior to predecessors and contradicting current medical practice.
Following those findings in 2007, the American College of Cardiology and the American Heart Association issued revised PCI guidelines for patients with no symptoms. The new study examined how the revised guidelines have been adopted and found they have not been implemented into practice in a large cross section of U.S. hospitals.
Writing the commentary about the study, Dr. Moscucci explored a number of reasons why the revisions have not been adopted, including physician barriers, patients’ preferences and environment-related barriers. He suggests that some physicians may not agree with the guidelines or the findings, or simply may not be aware of the change. Fear of liability related to the unknown or unrelated consequences of not performing the procedure and a desire to please referring physicians and to meet patients’ expectations might also contribute to the lack of adherence to the guidelines.
“The referring physicians and the patients themselves can play a role in the decision by expecting a certain procedure,” said Dr. Moscucci, a renowned interventional cardiologist. Still another reason may be human behavior. He cites an unrelated study which found that it is easier to have physicians adopt a new guideline implementing a new procedure or behavior, rather than a guideline eliminating a prior behavior.
Dr. Moscucci concludes that the obligation is on the physicians, who “must heed the call to professional responsibility aimed at the elimination of tests and treatments that do not result in any benefit for our patients, and for which the net effects will be added costs, waste, and possible harm.”
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