The current and future state of interventional cardiology: Insights from Dr. James Grattan

Increasingly, cardiologists are performing patient procedures in outpatient ASC facilities. This approach often makes sense since ASCs are less expensive than hospitals and often more convenient for patients.

Becker's Healthcare recently spoke with cardiologist James Grattan, MD, from Cardiologists of Lubbock (Texas), about the interventional cardiology landscape. He discussed how technology, partnerships and other factors are influencing care quality.

Interventional cardiologists are taking a multi-pronged approach to improving patient safety

Medical errors are the third leading cause of death in the United States. Top priorities for interventional cardiologists are understanding why this is happening, identifying the best solutions and then implementing them.

"When we treat patients in a hospital inpatient or outpatient setting, discharge planning nurses assess whether people can meet their needs at home or whether they need to go elsewhere to recover and get rehabilitation," Dr. Grattan said. "We are also trying to understand patients' ability to meet needs like filling their prescriptions."

For instance, some people may not have a car to drive to a pharmacy or money to cover prescription co-pays. Healthcare organizations have ways of helping, but early intervention is essential to prevent errors, including errors of omission — such as not recognizing that patients can't get their medications.

Teamwork and communication are also critical for patient safety and quality. When physicians, nurses and technicians feel like they are on the same team, patient communication improves. Patient satisfaction increases and patients leave with the proper follow-up plan and tools to navigate the healthcare system.

Another significant quality challenge in medicine is prevention.

"Patients are in charge of risk factors like blood pressure and cholesterol control, medication adherence and stress management," Dr. Grattan said. "If we don't have a relationship with people and motivate them, then care quality suffers. Patients must feel that they have a partnership with their physician."

When it comes to cardiac procedures in the ASC, patient selection is key to positive outcomes

Cardiac catheterizations and procedures for conditions such as peripheral vascular disease are increasingly performed at freestanding ASCs. Payers like CMS and commercial health insurance providers favor the ASC setting because it reduces costs. Patients also like ASCs because they can go home sooner, and the facilities are often more convenient.

However, complications still happen when cardiac procedures are performed in the outpatient setting. Patient selection is one way to increase the likelihood of positive outcomes.

"Patients directed to ASCs should be low risk," Dr. Grattan said. "Problematic risk factors include congestive heart failure, kidney and liver problems and previous strokes. These patients would be treated more safely in a hospital. I think we'll continue to see more procedures performed in freestanding ASCs, but we must prioritize safety."

Technology is advancing care delivery in interventional cardiology

In the ASC, most cardiologists now use radial access through an artery in the patient's arm, rather than access through the femoral artery. This approach enables patients to go home and ambulate sooner.

Other technology improvements include devices for recording heart rhythms. People can use a smartphone with an app on it and a finger device to tell if they have abnormal heart rhythms, such as atrial fibrillation.

"These innovations are vastly improving our ability to diagnose and treat rapidly before major complications or strokes happen," Dr. Grattan said.

AI is also beginning to play a role in improving care quality.

"In the future, I think AI-based systems will guide physicians through the proper diagnosis and treatment selection, and help patients navigate the system," Dr. Grattan said. "Robotic surgery has been done in several places, but it's not routine yet. Eventually, it will become the predominant way that cardiac procedures are done."

As interventional cardiologists explore the ASC market, partnerships can smooth the journey to growth and quality

Almost a decade ago, Surgery Partners became the majority owner of Cardiologists of Lubbock.

"The change has been positive and we've been very pleased with the results," Dr. Grattan said. "Surgery Partners has lowered our costs thanks to their purchasing power. In addition, their resources at the executive level have helped us recruit staff and physicians and create higher-quality approaches to care."

Cardiologists of Lubbock has its own quality improvement and quality assessment peer review groups. The team is also now part of Surgery Partners' quality group, which shares ideas across 180 locations about how practices can continue to improve and grow.


Looking ahead, the number of patients needing cardiac procedures will grow. However, interventional cardiologists will manage these cases more effectively in the outpatient setting thanks to preventive measures and medication.

"We've seen a decline in the death rate from heart disease in the last decade," Dr. Grattan said. "I see the future of heart care as very positive. We will continue to improve the quality and the length of patients' lives."

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