Radial access failure during PCI lengthens procedure time

Almost 1 in 10 patients (9.6%) experience radial access failure during primary PCI requiring crossover to the femoral artery.

A Victorian study of 2,256 STEMI patients treated between 2013 and 2020 found crossover patients after failed radial access had longer door-to-device times than patients with successful radial access (67 mins v 54 mins, P < 0.001).

Compared to the successful radial group, the crossover group experienced significantly higher all-cause bleeding (P < 0.001), but no difference in major bleeding (P = 0.535).

The most common reasons for crossover to trans-femoral access included puncture failure (33.9%), radial or subclavian artery tortuosity (20.5%) and difficulty engaging the catheter (14.6%).

Independent predictors of radial to femoral artery access crossover included female sex (AOR: 2.1, 95% CI: 1.4–3.0) and a history of hypertension (AOR: 1.5, 95% CI: 1.1–2.1).

“While a ‘radial-first’ approach is recommended for primary PCI in patients with STEMI, it is important for interventionalists and cardiology nurses to recognise patients who may be at increased risk for crossover to minimise vascular complications and delays to revascularisation.”

“They should however be prepared to ameliorate risk of crossover by employing available equipment and techniques on a patient-to-patient basis.”

Read more in Heart, Lung and Circulation

Disadvantaged patients have poor chest pain outcomes 

People residing in areas of lower socioeconomic status have about double the incidence of chest pain as people from higher SES areas.

A population‐based cohort study of ambulance, emergency, hospital admission, and mortality data in 183,232 Victorian adults with non-traumatic chest pain between 2015 and 2019 found 30-day and long-term outcomes were also poorer.

30-day mortality was higher in people from lower SES regions especially for non-ACS cardiac conditions and nonspecific chest pain.

“Rates of long-term mortality, reattendance for chest pain, and reattendance for ACS were higher among lower SES quintiles across a median follow-up period of 2.3 years (IQR, 1.3–3.5 years) for mortality and 1.9 years (IQR, 0.9–3.2 years) for reattendance,” the study said.

“The substantial socioeconomic gradient for age-adjusted chest pain incidence in our study represents not only greater ACS rates in patients of lower SES but also greater presentations for nonspecific chest pain; non-ACS cardiac disorders; and disorders of the respiratory, gastrointestinal, rheumatological, mental health, and other organ systems.”

The researchers said improvements in these disparities should be a focus for health policy.

Read more in the Journal of the American Heart Association

Doctors win, nurses lose under tax changes

High income medical specialists such as surgeons will get a $9,000 windfall from the government’s planned stage 3 tax cuts, whereas other healthcare workers such as nurses will be worse off, a new analysis suggests.

The stage 3 tax cuts, worth $15.7 billion per year will come into effect in July 2024, and will increase the income at which the top tax bracket begins from $180,001 to $200,000.

According to the Australia Institute think tank, this will mean that medical practitioners such as surgeons and anaesthetists with average incomes over $200,000 will get the maximum tax cut worth $9,075 per year.

In contrast, healthcare occupations that currently qualify for the Low- and Middle-Income Tax Offset (LMITO), worth $7 billion per year, will be net losers when it is discontinued at the of end this year, the institute says.

It cites the example of a midwife with a salary of $78,784 who will gain $845 from the stage 3 tax cuts but lose $1,080 when the LMITO is removed.

Workers on incomes below $50,000 such as aged care staff, secretaries and receptionists will be worst off, receiving no tax cuts and losing up to $832 from the LMITO, the institute predicts.