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

Monika Kodeboina, Kerstin Piayda, Inge Jenniskens, Pearl Vyas, Sara Chen, Ramon Julian Pesigan, Nicole Ferko, Barkha P. Patel, Annamaria Dobrin, Jayson Habib and Jennifer Franke ()
Additional contact information
Monika Kodeboina: Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium
Kerstin Piayda: Cardiovascular Center Frankfurt, 60389 Frankfurt, Germany
Inge Jenniskens: Philips, 5684 PC Best, The Netherlands
Pearl Vyas: Philips, 5684 PC Best, The Netherlands
Sara Chen: Philips, San Diego, CA 92130, USA
Ramon Julian Pesigan: Philips, 5684 PC Best, The Netherlands
Nicole Ferko: EVERSANA, Burlington, ON L7N 3H8, Canada
Barkha P. Patel: EVERSANA, Burlington, ON L7N 3H8, Canada
Annamaria Dobrin: EVERSANA, Burlington, ON L7N 3H8, Canada
Jayson Habib: EVERSANA, Burlington, ON L7N 3H8, Canada
Jennifer Franke: Cardiovascular Center Frankfurt, 60389 Frankfurt, Germany

IJERPH, 2023, vol. 20, issue 9, 1-26

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: coronary artery disease; treatment; percutaneous coronary intervention; echocardiography; myocardial ischemia; diagnostic imaging; integration; automation; inefficiencies; burdens (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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