Journal of Invasive Cardiology

The most common theme of my blogs for the Journal of Invasive Cardiology has been that we have an image problem.  I have now had an opportunity to do a little something about that, after SCAI took a suggestion of mine and made something happen. One night last winter I sat back in my chair and flipped on the TV.  I immediately sa

I am more confused by FDA labeling now than ever before. More importantly, the vagaries of FDA labeling are beginning to have an even greater impact on the interventional cardiologist than ever before. Recently, our local Blue Cross has enacted a policy to automatically deny PFO closure (a common phenomenon across the country). They justify their stance by pointing out that closure of a PFO requires an off-label use of a device (unless the patient is receiving a designated PFO occluder device as part of a research study). Their seemingly shocked response as to why they are denying these cases is almost comical — reminiscent of the famous line in the movie Casablanca (“I am shocked, shocked to discover there is gambling in this institution” as Claude Rains collects his gambling winnings). Of course they are aware this is an off-label use of ASD or VSD devices, but their pretense suggests that they would never consider it appropriate to authorize or support anything off-label.

Urban legends intrigue me. They are either very prevalent in medicine, or the challenges of documenting simple, common observations are deeper than it would seem likely. An example is the use of low-molecular-weight heparin after a cardiac catheterization procedure. I am not referring to its use in acute coronary syndromes, which was tested in the ACUITY trial. I am referring to the use of these compounds after a diagnostic study or intervention. This is where the “urban legend” comes in. I have heard several reports that low-molecular-weight heparin has been associated with late v

Washington state has convened a Health Technology Assessment program to evaluate for therapies which are deemed insufficiently cost-effective for state-sponsored insurance programs to cover. They decided to address drug-eluting stents (as opposed to bare metal stents) and I was invited to be a consultant for this process, along with several other physicians, most of whom were not interventional cardiologists. As we discussed the relative merits of drug-eluting stents versus bare metal stents for a variety of conditions, a consistent theme kept cropping up from those who were not interventio