Challenges and Burdens in the Coronary Artery Disease Care Pathway for Patients Undergoing Percutaneous Coronary Intervention: A Contemporary Narrative Review

Abstract

Clinical and economic burdens exist within the coronary artery disease (CAD) care pathway despite advances in diagnosis and treatment and the increasing utilization of percutaneous coronary intervention (PCI). However, research presenting a comprehensive assessment of the challenges across this pathway is scarce. This contemporary review identifies relevant studies related to inefficiencies in the diagnosis, treatment, and management of CAD, including clinician, patient, and economic burdens. Studies demonstrating the benefits of integration and automation within the catheterization laboratory and across the CAD care pathway were also included. Most studies were published in the last 5-10 years and focused on North America and Europe. The review demonstrated multiple potentially avoidable inefficiencies, with a focus on access, appropriate use, conduct, and follow-up related to PCI. Inefficiencies included misdiagnosis, delays in emergency care, suboptimal testing, longer procedure times, risk of recurrent cardiac events, incomplete treatment, and challenges accessing and adhering to post-acute care. Across the CAD pathway, this review revealed that high clinician burnout, complex technologies, radiation, and contrast media exposure, amongst others, negatively impact workflow and patient care. Potential solutions include greater integration and interoperability between technologies and systems, improved standardization, and increased automation to reduce burdens in CAD and improve patient outcomes.

Keywords: automation; burdens; coronary artery disease; diagnostic imaging; echocardiography; inefficiencies; integration; myocardial ischemia; percutaneous coronary intervention; treatment.

Figure 1

Critical success factors to address inefficiencies in the CAD care pathway: (1) better integration of heterogenous medical devices (i.e., integrated systems with digital controls to dynamically manage multiple devices and improve workflow); (2) enhanced system interoperability (i.e., interoperable medical devices that effortlessly communicate with other devices through a common language to reduce errors); (3) increased utilization of health information exchange (i.e., quick and efficient transfer of critical medical information/tests); (4) improved standardization (i.e., standardized documentation templates for structured reporting to decrease workload); (5) increased automation of manual processes (i.e., automated processes can facilitate image interpretations to improve confidence and accuracy); (6) user-friendly technological interfaces (i.e., easily accessible web-based interfaces in the catheterization lab that enhance the user experience). CAD: coronary artery disease.