• Close to Home: Angioplasty at Community Hospital Can Be as Safe as at Large Hospitals

    For any non-emergency hospital procedure, you should weigh the benefits and drawbacks of where you will seek treatment. You may choose to have treatment at a hospital that is close to home and easy for family and friends to access. In other circumstances, you may be willing to travel hundreds of miles to receive the most advanced treatment. Recent studies suggest that for elective (non-emergency) angioplasty, it's not an "either/or" decision. In fact, a recent study seems to confirm that community hospitals can perform elective angioplasty as safely and effectively as their larger counterparts.

    What Is Elective Angioplasty?

    Elective angioplasty is a minimally invasive procedure used to clear a blockage in an artery that supplies the heart muscle with blood. Reopening a blocked artery to stop a heart attack is emergency angioplasty.

    Elective angioplasty is when the procedure is used to clear one or more significant artery blockages that are not life threatening but that may be causing heart disease symptoms, such as chest pain (angina), shortness of breath or chronic fatigue.

    An angioplasty procedure is performed in a hospital by an interventional cardiologist, a heart doctor with specialized education and training in treating blocked arteries without open-heart surgery. Interventional cardiologists use thin tubes called catheters as well as tiny balloons and stents to restore blood flow through the arteries.

    Does Hospital Location Matter for Elective Angioplasty?

    It is an ongoing question in the world of cardiac care: Can community hospitals provide elective angioplasty that is as safe as at large hospitals? The concern has been whether smaller hospitals that do not have the capability to provide emergency open-heart bypass surgery would be placing patients at risk if they offered angioplasty.

    In the early days of angioplasty, patients who underwent an angioplasty procedure faced a significant risk that the procedure might have to be stopped and an emergency bypass operation performed. That's why it was a requirement that angioplasty could be performed only at centers where operating rooms and heart surgeons were available on-site.

    Fortunately, angioplasty technology has improved over the last 35 years, making it the best treatment choice for many patients, especially those suffering a heart attack. It is now rare for angioplasty patients to need emergency bypass surgery. With this improvement, the need for on-site surgical capabilities has been questioned. Recent studies of hospitals, in Massachusetts specifically and nationwide, have found that the results at medical centers without on-site surgery were the same as those with on-site surgery.

    Elective Angioplasty at Your Community Hospital

    In some states, hospitals are not legally permitted to perform elective angioplasty unless open-heart surgery care is also available on-site. In other states, community hospitals are now permitted to perform elective angioplasty without an on-site surgical program only if they have certain policies and safety precautions in place. For example, a community hospital must have an established relationship with a larger hospital to which they can quickly send an angioplasty patient if emergency surgery is required. When choosing a hospital for your elective angioplasty, you should consider this as well as the experience of the hospital and care team in performing angioplasty procedures.

    One interesting point raised by the recent research is that the success rates at community hospitals may be in part because interventional cardiologists have become very skilled at identifying which patients are good candidates for treatment at that hospital and which patients would be better treated at a medical center with on-site surgical capabilities. Many physicians have privileges at more than one hospital. This means they are allowed to treat patients at these hospitals. These doctors are likely to bring the experience needed to perform more complex angioplasty procedures to a larger medical center with on-site surgery. Or they may refer more complex procedures to colleagues at the larger medical center. When discussing elective angioplasty with your physician, you can explore whether your community hospital performs elective angioplasty, and whether treatment at that location is the best option for you.

    The Future of Community Hospitals and Elective Angioplasty

    Emerging research will likely begin discussions about whether every hospital should provide angioplasty procedures. It is a complex question. From one perspective, it is always nice to receive your healthcare close to home. On the other hand, having a surgical team available is beneficial, especially for complex situations.

    It is important to note that the success of angioplasty relies not just on your doctor, but on all of the nurses, technologists and the rest of the care team. And the more of these procedures they perform, the more expert they all become. The recent studies show that it can be done. You can expect to see more discussion on how often and where elective angioplasty should be offered.