Article preview from Medtech Insight - January , 2012
Fractional flow reserve (FFR), a measurement of the severity of a coronary artery obstruction, has not yet reached mainstream use in the US, but that could soon change as interventional cardiologists face increased scrutiny about the “appropriateness” of their clinical treatment decisions. Part of that scrutiny will be driven by recent overstenting scandals, but cost-control measures are playing just much of a role in this shift. At the same time, ongoing advancements in FFR technology are helping to overcome barriers to use and could convince more physicians and hospitals to jump on the FFR bandwagon.
Article preview from Medtech Insight - January , 2012
Fractional flow reserve (FFR), a functional measurement of arterial blood flow typically performed during coronary angiography, is slowly beginning to gain traction among US interventional cardiologists seeking additional surety that a patient’s blocked coronary artery needs to be stented. Although FFR is currently used in fewer than 10% of US stenting cases, that number is expected to rise substantially in the coming years as intense cost-control measures come into play and physicians face increasing pressures to reduce unnecessary stenting procedures. And now, what might be described as a second generation of FFR is emerging that has the potential to leap-frog over existing FFR technology. This wave of next-generation technology includes noninvasive computed tomography (CT)-based FFR, developed by start-up HeartFlow Inc., as well as a new adenosine-free FFR technology under development by Volcano Corp. in collaboration with researchers from Imperial College London.
The basic goals of these new approaches are to make FFR measurements more reliable, more versatile, and/or easier to perform, with the ultimate aim of taking FFR from the fringe of clinical use into the mainstream. In fact, FFR, together with recent advances in cardiac imaging technology, could have a large role to play in future decisions about the appropriateness of coronary interventions, and providers and manufacturers as well as payors are keeping a close eye on developments in this field.
Writing in the September 2011 issue of the Journal of the American College of Cardiology, Neal S. Kleiman, MD, director of cardiac catheterization laboratories at Houston’s Methodist DeBakey Heart and Vascular Center estimated that FFR is currently used in only about 6% of US stenting cases. The number is low, but the economic payoff for expanded FFR utilization over the coming years could be substantial. Medicare paid out an estimated $3.5 billion in 2009 alone for cardiac stents. Should stepped up utilization of FFR shave the number of stents placed in US patients by just 10%, those functional measurements could account for as much as $350 million in annual Medicare savings in product expenditures alone.
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