By Westby G. Fisher, MD, FACC
Cardiovascular predictions for next year are always fun to contemplate this time of year. So much is happening to the practice of medicine as we've known it that it can be helpful to highlight some of those changes, both good and bad, as our medical world continues to evolve. While these predictions contain pure guesses, they also contain one doctor's observations of our new evolving medical world. Many of these changes will profoundly shape how doctors interact with their patients.
So grab some coffee and strap in. Here are my 2013 predictions of life as a cardiologist in 2013. (Please feel free to add your own predictions in the comments section.)
Valvular Heart Disease
- TAVR for critical aortic stenosis will be applied to progressively younger and healthier patients.
- As smaller delivery systems for percutaneous heart valves gain widespread acceptance, government payers will look for new and inventive techniques to restrict patient access to these devices. No heart valve will remain untouched as creative uses of the approved devices are attempted in non-surgical patients.
- Innovations valve design will improve the safety and effectiveness of this therapy.
Ischemic Heart Disease
- The push for more drugs and less stenting will continue in stable ischemic coronary disease.
- Acceptable (payable) door-to-balloon times will shrink from 90 to 60 minutes as payers give the most reimbursement for centers with the faster times.
- Radial artery catheterization and interventions will grow in acceptance and CABG will continue to have a more prominent roll for severe 3v disease (continuing the "reduced stenting" theme) compared to multi-vessel stenting.
- Lipid therapy recommendations will remain unchanged.