Wednesday, November 18, 2009

For many years, Lower Keys Medical Center has attempted to provide the citizens of Key West with contemporary medical care. The hospital facility, administration and the professional staff have always placed optimal patient care as their primary goal of success. The quality of service, as well as the hospital's fine physicians, exceeds expectations one might have for a small rurally designated facility.

We, at the University of Miami Hospital, along with our Keys physician partners, primarily Drs. Bruce Boros, David J. Schreiber and Richard Berger, are proud of the association that we have fostered over the years. In the medical subspecialty of cardiovascular medicine, we have provided prompt, sophisticated service for the Florida Keys, particularly the Lower Keys.

Recently we noted an article in the Key West Citizen that introduces the concept of an outpatient cardiac catheterization laboratory scheduled to open shortly at Lower Florida Keys Medical Center.

We are very concerned that this article does not address the proper indications for such a venture, nor does it address the potential complications of such a lab.

First, any procedure managed as safely and efficiently in Key West as it could be provided at a tertiary facility in Miami would be a benefit to the Lower Keys population. We all agree that patients are best treated close to home if the risk and cost are not significantly different from those procedures completed traditionally and safely in a large high-volume cardiac-oriented hospital.

Drs. Boros and Berger have, through the years, brought many new technologies to the Lower Keys that in the recent past were only available on the mainland.

We have, however, avoided an outpatient cardiac cath lab, as the potential for complications is very real and the backup support for the complications of a cardiac cath is limited. With very few exceptions, patients are treated less expensively, more efficiently and with greater safety in a cardiac catheterization laboratory that is staffed by a skilled cardiologist, with a support team that is doing more than a few cardiac caths a week at the most. This is considered a low-volume cath lab. A high-volume cath lab does 20 or more procedures a day.

A high-volume lab is staffed by personnel very experienced in dealing with patients having a cardiac catheterization, which translates into reduced complications.

Having reviewed our number of cardiac cath cases over the last 20 years of being the primary providers of cardiovascular care in the Lower Keys, 125 patients per year at most might be considered "diagnostic caths." This equates to about three cases per week, far below what is necessary to be considered a high-volume cardiac cath lab.

Dr. William O'Neill, chief medical executive officer of University of Miami Hospital and world-renowned interventional cardiologist has recently published in the Journal of the American College of Cardiology an editorial which is consistent with the long-held position of Drs. Boros and Berger. There are significant downsides of an outpatient cath lab in the Lower Keys.

Lower Keys Medical Center currently has in place an immediate emergency and perpetual acute source for sophisticated cardiac care via the University of Miami cardiac team, as mentioned earlier. In most cases, patients with an acute heart attack can be immediately transported to University of Miami Hospital and receive the highest quality care within 45 minutes of arriving in the emergency room. Complete backup for all potential complications are on hand.

Diagnostic cardiac cath is all that can be offered at our Keys hospital. The same type of information can usually be obtained by using CT angiography. This technology is available with the 64-slice CT machine currently used at the Diagnostic Imaging Center on Duck Avenue in Key West. This is a non-invasive, less expensive, low risk and highly accurate procedure whose results compare very well with patients who are sent for diagnostic cath.

Finally, for the small number of patients receiving a diagnostic cardiac cath, a percentage of those will need a second invasive procedure to treat the findings. Florida guidelines do not permit coronary angioplasties/stents in hospitals that do not have open-heart surgical programs on site.

In summary, patient care and safety has always been the priority of Drs. Boros and Berger. They have a superb relationship with University of Miami Hospital, which is always available for their patients.

Bruce Boros is a Key West-based cardiologist and associate professor at the University of Miami Miller School of Medicine. Richard Berger is a cardiologist at the University of Miami Hospital. William O'Neill is the executive dean of clinical affairs at the University of Miami Miller School of Medicine.