Clinical evidence presented at ACC.23/WCC highlights how utilization of Philips cardiology solutions is improving the quality and efficiency of patient care

“To make a real difference to patients, it is vitally important that medical innovations are validated in real-life clinical practice so that clinician decision-making and guideline setting are firmly evidence-based. At Philips, we are deeply committed to making sure this is the case,” said Dr. Atul Gupta, Chief Medical Officer for Image-Guided Therapy at Philips. “The positive clinical study results announced today are further evidence of how we are continuously working with our clinical partners to co-create new innovations and demonstrate how they improve outcomes for patients.”

Dr. Eric Secemsky at Beth Israel Deaconess Medical Center and his collaborators conducted a high-quality real-world evidence study of Medicare data for over one million patients undergoing PCI procedures between January 1, 2013, and December 31, 2019. The preliminary results, which were presented at ACC.23/WCC by Dr. Reza Fazel, reveal that the use of intravascular imaging (IVI) technologies as an adjunct to angiography rose by 62% during the period and is associated with superior patient outcomes. The potential for further strong growth is supported by a recent review published in the Journal of the American College of Cardiology (JACC), which “advocates broader use of these technologies as a part of contemporary practice” and recommends that “IVI capability should be included in all U.S. CCLs [cardiac catheterization laboratories]” [1]. Dr. Fazel’s presentation highlighted some of the benefits that could accrue from such a move. The retrospective real-world study showed that IVI use during PCI procedures was associated with lower rates of one-year mortality (Hazard Ratio 0.96, 95% CI 0.94-0.98)**, myocardial infarction (MI), repeat PCI procedures, and major adverse cardiac event (MACE). It is one of the first studies to include outpatient procedures, which accounted for 43.3% of all the PCIs included in the analysis.

Philips’ IVI offering comprises a range of intravascular ultrasound (IVUS) catheters, co-registration and automated measurement tools for use on Philips Image-Guided Therapy System – Azurion, designed to help cardiologists decide, guide, and confirm the right interventional treatment for each patient. The patient benefits of these tools have already been demonstrated in multiple clinical studies. The JACC review paper referred to above states that IVUS is “the more flexible of the options and is the one that can be utilized in almost all clinical scenarios” [1].

The CIED Infection Medicare Study* of clinical practice was conducted by Dr. Sean Pokorney and his team at the Duke Clinical Research Institute, which analyzed the records of more than one million CIED implant patients in the ‘U.S. 100% Medicare fee-for-service’ population covering the period January 1, 2006, to December 31, 2019.

The study represented a nationwide analysis of CIED infection care, and as already reported by Dr. Pokorney at last year’s ACC (ACC.22) [2], demonstrated that approximately 4 in 5 patients were not treated [2] according to ACC/AHA/HRS/EHRA Class I consensus recommendations and guidelines for CIED infection, which recommend full system extraction ideally within 3 days [3,4]. Of the 9,867 patients diagnosed with a CIED infection 12 months or more after implantation, only 13.3% underwent extraction within six days and only 5.2% between seven and 30 days.

“This data highlights a major gap in care among our CIED infection patients, which results in higher mortality, more health care utilization, and higher cost of care. Quality improvement interventions with focused systems of care are needed to optimize patient outcomes,” commented Dr. Pokorney.

Dr. Pokorney’s presentation at ACC.23/WCC highlighted the cumulative incidence of all-cause hospitalization and the associated healthcare expenditure for these patients during a period of one year after infection diagnosis. Complete device extraction within six days of CIED infection diagnosis was associated with lower all-cause hospitalization in follow-up (21% lower) and lower healthcare expenditure (42% lower) compared with patients who did not undergo extraction [5]. Timely extraction was also associated with lower hospitalization rates. The patient group for which no device extraction within 30 days of diagnosis took place was characterized by a 68% hospitalization rate compared to a 54% hospitalization rate for the group in which patients underwent CEID extraction within six days of diagnosis. Additionally, hospital expenditures in the year following a CIED infection were almost cut in half, with costs being USD 63,259 for the group with no extraction within 30 days, reducing to USD 36,815 for extraction within six days.

Dr. John Andriulli added: “CIED infection is a healthcare crisis and EMR (electronic medical records) are essential in identifying patients and minimizing time to extraction.  It must be ubiquitously shared between hospital systems to improve length of stay and more importantly to impact the potential reduction in mortality. This is especially true for outside hospital transfers. This is when the EMR becomes even more important.”

The prospective, non-randomized, multi-center, observational study*** into the safety and performance of Philips 3D Intracardiac Echocardiography Catheter (ICE) – VeriSight Pro – was led by Dr. Mohamad Alkhouli at Mayo Clinic School of Medicine. The study was based on a cohort of 155 patients evaluated for a range of percutaneous cardiac intervention procedures, including left atrial appendage occlusion (LAAO), cardiac ablation, heart valve replacement, and patent foramen ovale (PFO) as well as atrial septal defect (ASD) ‘hole-in-the-heart’ repair procedures.

Compared to TEE, which involves passing an ultrasound transducer deep into the patient’s esophagus, an ICE catheter has a tip-mounted ultrasound transducer that can be routed to the heart via the patient’s blood vessels and a small incision in the skin. For the majority of patients, ICE is considerably more comfortable than TEE and requires less sedation or anesthesia, improving patient safety and experience and reducing the number of operating room staff required during a procedure.

During the study, patients were followed until discharge or 48 hours after their procedure, with safety demonstrated by the fact that no periprocedural device-related adverse events were reported. Philips VeriSight Pro 3D ICE demonstrated acceptable or better image quality compared to TEE or competitive ICE technology in over 95% of the procedures. VeriSight Pro 3D ICE was considered to be an acceptable or better surrogate to TEE 89.7% of the time.

All three clinical studies are part of more than 110 ongoing clinical studies that support Philips image-guided therapy solutions with clinical evidence. For ten consecutive years, Philips has been recognized as a top innovator in the Clarivate Top 100 Global Innovator list.

For more information on innovation at Philips, click here.

* Supported by a research grant from Philips. Philips had no role in the design of the study or conduct of the analysis.

** In the Secemsky study, the Hazard Ratio of 0.96 implies that patients undergoing PCI using angiography and IVI imaging during PCI have a 4% lower risk of dying during the following year than patients undergoing PCI using angiography alone.