American Heart Association: Patient-centered imaging is at the ‘heart’ of patient-centered care

Patient-centered care isn’t achievable without patient-centered imaging. Upon this obvious yet easily overlooked principle, the American Heart Association is urging heart doctors across various subspecialties to talk to patients about radiation risks before imaging their chests.

“Empowering patients with knowledge of the benefits and risks of imaging will facilitate their meaningful participation in decisions related to their health care,” write the authors of the scientific statement containing the advisement.

The 18-page statement, published in the AHA journal Circulation, presents numerous strategies and recommendations for making sure patients fully grasp the minor risks of radiation-related cancers following chest imaging—and understand such risks in the context of chest imaging’s potentially life-saving benefits.

Patient-centered imaging “takes into account patient values and preferences, as well as specifics of the patient’s epidemiological characteristics and clinical scenario,” the authors write. “This approach expresses partnership with the patient, strengthens the patient-physician relationship, provides an excellent platform to obtain informed consent and reduces the risk for medicolegal liability.”

Noting that many patients have questions about radiation, and that clinical and scientific answers sometimes confuse rather than clarify, the statement promotes several specific communications techniques, including:

·       Providing the patient with key facts regarding the procedure using simple language that highlights the benefits of an accurate diagnosis and the importance of early detection and therapeutic intervention;

·       Affirmation that their imaging study is appropriate (or uncertain/may be appropriate) based on the American College of Cardiology Foundation’s appropriate use criteria;

·       Creating a dialogue and allowing the patient to ask questions;

·       Directly addressing patient and family concerns regarding risks of the procedure, including those related to ionizing radiation, contrast media and anesthesia, if relevant; and

·       Comparing risk estimates as a result of exposure to ionizing radiation to commonly performed tasks, such as driving a car.

The statement explains that implementing patient-centered imaging in clinical practice requires attention to several key principles. High among these is the need to avoid unnecessary serial imaging. “A conscientious effort to obtain and review patient records, including those from other medical institutions, should be made before an imaging study is requested to ensure that such procedures are not repeated needlessly,” the authors write.

Taking on the challenges likely to confront care teams seeking to implement patient-centered imaging, the authors present a puzzler: Neither the benefits nor the risks of a cardiac imaging study for a given patient in a given clinical scenario can be precisely quantified. For that reason, quantitative benefit-risk comparison “is generally not feasible,” they allow. “However, because the potential risks related to any cardiac imaging study are very small in general, the limitation of studies to appropriate clinical indications ensures that the benefits of the study far outweigh any potential risks.”

Another source of likely trouble is time constraints—a given in a busy clinical practice. There are only so many hours in a workday, a reality that can “create a substantial barrier to a thorough and balanced discussion of the benefits and risks of imaging with patients,” the authors write. “The development of strategies to streamline the process of informing patients in these settings, such as training staff for this purpose or developing educational material for patients (videos, interactive websites, brochures) is essential.”

In practice, much of the AHA statement may strike some heart-imaging care teams more as reminder than informer.

At St. Joseph’s/Candler health system in Savannah, Ga., Jeff Zehel, director of imaging services, tells imagingBiz that his team ties patient-centered imaging with high-tech dose reduction—which they connect just as closely with the human touch across all specialties. The SJ/C provider network uses a sophisticated, data analytics-based system for tracking radiation doses, but, says Zehel, “our physicians and staff are championing the effort, creating the processes and structure to support our initiatives outside of [using] the technology that drives it.”

A recent European study showed that cardiology accounts for 40% of patient radiation exposure. Zehel adds: “We’re specifically interested in using our tracking data to inform our departments and individual physicians of their own progress. We are able to present a report at a cardiology department meeting, for example, so that our cardiologists can evaluate their department progress month over month, as well as that of each cardiologist, as compared to his or her peers.”

Not all hospitals and health systems are as forward-thinking on patient-centered heart imaging, which may be one reason the AHA sought and won endorsements to stamp the document as not only authoritative but also essential. Groups putting their weight behind the statement include the American College of Cardiology, American Society of Nuclear Cardiology, North American Society for Cardiovascular Imaging, Society of Cardiovascular Computed Tomography, and Society for Coronary Angiography and Interventions.

The AHA’s scientific statement, “Approaches to Enhancing Radiation Safety in Cardiovascular Imaging,” is posted in its entirety here.