Catheterization from the Wrist Taking Over

Just recently, cardiac catheterization from the wrist, or transradial cardiac catheterization, was featured on the Dr. Oz show and immediately we were fielding questions about it in the office and reading about it on the blogs.

Now, even more impactful, was the recent recommendation from the European Society of Cardiology that the radial approach should be considered as the first-line access site:

“The radial approach for percutaneous coronary interventions (PCI) was developed 20 years ago and is used for more than 50% of procedures in France, Scandinavian countries, the UK, Spain and Italy. Despite the advantages of radial access some countries in Europe such as Germany use radial access for fewer than 10% of PCI….

“Evidence has accumulated in the literature showing the benefits of radial over femoral access for PCI including reduced bleeding and improved survival. In addition, the development of smaller and thinner devices has made the radial approach increasingly practical.”

For most of us in the interventional cardiology world, the radial approach has been slowly gaining traction over the past 5 years in the US. As of 2007, less than 2% of all coronary stent procedures were done from the wrist but in 2012, according to the National Cardiovascular Data Registry (NCDR) more than 11%  were done radial style.

Patient safety and comfort are always a concern to physicians and the radial approach has shown superiority to the femoral (groin) approach in both categories. In terms of safety, numerous studies have shown significantly less bleeding complications as compared with the femoral approach. This is in large part due to the fact that unlike the radial artery, which is bordered by bone and connective tissue, the femoral artery lies right next to a large caliber femoral vein and complications can be difficult to identify at first because of the large potential space for blood to go, i.e. the thigh or abdomen. Women are actually at higher risk of groin complications from cardiac cath and currently Dr. Safirstein is the Principle Investigator of SAFE-PCI, a multicenter, randomized control trial looking at the benefits of the radial approach in women, run in collaboration with more than 25 of the best coronary centers of excellence across the US.

Comparing comfort of the 2 techniques, it is not hard to see why patients have preferred radial more than 90% of the time. Cath from the wrist allows patients to sit up immediately after the procedure (even when a stent is placed) with a pressure dressing over the small puncture site on the wrist. The femoral approach demands anywhere from 4-8 hours of lying flat so as not to disrupt the clot that forms over the femoral puncture site. This becomes particularly relevant in patients who have back pain issues or cannot lie flat for any reason.

From a cost standpoint, less complications mean less money spent on follow-up imaging studies, blood products that might be required, consults with other specialists, and of course, length of stay. The radial approach has been shown to save both hospitals and patients money and time in the hospital.

Drs. Safirstein and Fusman both are proficient in radial cath and Dr. Safirstein served as the Director of Transradial Intervention at Morristown Medical Center. Later this year, he will be Course Director for the annual Mid-Atlantic Radial Symposium (MARS2013), hosting world-renowned experts who will educate both physicians and cath lab staff from NY/NJ/PA on everything transradial!

Which State is the Healthiest? Where Does Jersey Stand?

All this talk about Disney's lack of healthy food options made me curious about which states are actually the healthiest overall.

It turns out that there is extensive data cultivated by the United Health Foundation on how states fare in a variety of outcome measures including smoking, obesity, cardiovascular deaths, etc etc

Well, we love a good rank list so we picked the most interesting points to share with you and then you're on your own to peruse the entire report on their website at America's Health Ranking.

First, let's look at the 2010 national numbers and then we'll go local.

Besides bucolic scenery, bed and breakfasts, old liberal arts colleges, and Yankee-hating, the New England states also excel at many of the important health measures. All six New England states, with Vermont leading the way, were in the Top 10 in overall health outcomes, in part because of their low rates of smoking and obesity, as well as a large number of doctors per capita, and strong emphasis on public health.

The southern states, while also excelling at Yankee-hating (of a different sort) unfortunately did not fare so well as they comprised 8 of the bottom 10. And Mississippi has the dubious honor of finishing at rock bottom for the 9th consecutive year because of its disproportionately high rates of cardiovascular deaths, obesity, prevalence of smoking and lack of insurance coverage - add to that a relatively low density of physicians per capita, plus child poverty and it's a perfect storm for bad health. To be fair, most of the poorly performing states did show significant improvement from 2009.

So how does the Garden State compare in all these measures? In 2010, we were ranked 17th overall, up 1 place from 2009. North Dakota is a little better and Wisconsin is a little worse. According to America's Health Rankings, our strengths are lower rates of obesity and impoverished children as well as higher rates of high school graduation and  ready availability of primary care MDs.

When you look a little deeper though it's scary that our percentage of obesity (23.9%), almost one-quarter of the population, is comparatively low - Mississippi's rate is 35.3%. Other Jersey high notes include improvements in our air quality and decreasing rates of children in poverty and violent crime.

While we write about things with a sense of humor,  healthy eating and obesity is an enormous problem in this country (pun intended) - and it's not getting any smaller. Look at the graphic above depicting percentage of obese US citizens over the past 20 years. Scary. Along with obesity comes increasing rates of diabetes, heart disease, and a host of other health issues is that's not enough. Education and proper eating habits are the groundwork for a healthier generation of children.

Stay tuned for our next post about peripheral artery disease and if you have suggestions for other topics please feel free to post them in the comments section. Stay healthy!


America's Health Rankings® employs a unique methodology, developed and periodically reviewed by a panel of leading public health scholars, which balances the contributions of various factors, such as smoking, obesity, binge drinking, high school graduation rates, children in poverty, access to care and incidence of preventable disease, to a state's health. The report is based on data from the U.S. Departments of Health and Human Services, Commerce, Education and Labor; U.S. Environmental Protection Agency;the American Medical Association;the Dartmouth Atlas Project; the Trust for America's Health;the World Health Organization; and the Organisation for Economic Co-operation and Development (OECD).