What Patients Know About Their Implanted Coronary Stents: Not Enough, According to Morristown Medical Center Study

Fewer than half (48%) of patients receiving a heart stent, or percutaneous coronary intervention (PCI), had the provided stent card with them when surveyed at a later date, according to researchers at Atlantic Health System’s Morristown Medical Center.  Even when they had their stent cards, most patients were unable to identify the type of stent they had, which blood vessel it was in, or the date of the previous procedure.  Eighty-eight percent of patients did have their smartphone, however. The study will be presented as a moderated poster the morning of May 15, during the American College of Cardiology 70^th Annual Scientific Session (ACC.21).

“Stent design has advanced significantly since the mid-1990s, with the evolution of new polymers and advanced drug-eluting stents,” said lead author Jordan G. Safirstein, MD, FACC, FSCAI, director of transradial catheterization for Morristown Medical Center and a nationally recognized thought leader on transradial (wrist) catheterization and stenting.  

He added, “Since that time, email, the Internet and smartphone technologies have been developed. Despite these major technological changes, what we provide to patients hasn’t changed at all—a card containing all of their stent implantation details. When someone comes in for a new PCI procedure it is critical that we know the date of their earlier procedure, vessel location, size and type of stent (bare metal vs. drug eluting). These are all critical factors in our decision making about new stenting.”

Approximately one million PCIs are performed each year in the United States. Patients are provided wallet-sized cardboard cards with the type, size, date, and vessel for the coronary stent. The objective of this study was to evaluate patients’ retention of their stent card, knowledge of their most recent stent procedure, and willingness to use digital tools, such as smartphone apps, to keep track of their implantable devices.

For the study, entitled, “Knowledge Retention After Percutaneous Coronary Intervention,” the research team asked 313 patients having a PCI, who already had one or more stents, to complete a survey assessing whether they had their stent card, knowledge of stent information (date, type, vessel) and whether they were currently carrying a mobile device. Patients were permitted to use the stent card, if in their possession, to complete the survey. Patients were surveyed in the emergency room, cardiologist’s office, cath lab and inpatient cardiac unit. The survey was fielded April 2019-March 2020.

All study participants’ responses were validated by the study team. Statistical techniques—measures of central tendency, univariable, and regression analyses—were used for demographic and predictive analysis.

Study participants had a median time of three years from the time of their earlier stent procedure to their new PCI. 

There was no significant difference between those who had their card and those who did not, with regard to age, race, level of education, annual income or frequency of concomitant (comorbid) health conditions. Even with the stent card, only 11.4% were able to correctly identify date, vessel and type of stent. Presence of the stent card increased the likelihood (2.5 times) that patients could identify the vessel stented. Statistical methods (univariable regression) indicated that age and time from PCI had a negative effect on correct stent information—that is, the older the patient was and/or the longer it had been since their previous PCI, the less likely they were to recall correct information on their stent. Of the 313 patients, 88.2% had their cell phone with them and 74.5% responded that they would be willing to use it to store medical information.

The authors noted, “To our knowledge, this is the first study to assess individuals’ recall of stent details after PCI. These data demonstrate poor retention of both stent cards and critical information related to their stent, even with stent card present, highlighting the cards’ failure as an effective modality to provide a durable, portable health care record. Research to date regarding health-related smartphone applications has focused more on an individual’s behavioral health changes and less on the retention of implanted medical device information.  A smartphone application that retains medical device information may have clinical significance in the rapid and reliable information exchange between a patient and their health care provider.”

“The vast majority of patients would use their phone for stent device-related purposes,” said Dr. Safirstein. “The only age group that was significantly less likely to do so was those over age 80.  We know that a Web-based mobile app facilitated by bar code/QR code scanning, which is HIPAA compliant, is in development and we believe it to be necessary.  Our study’s results will engender growth of digital tools to provide patients with lasting and accurate information about their implantable devices.”   

Study co-authors include Stephanie Chiu, MPH, Lise Cooper, DMH, Mildred Ortu Kowalski, PhD, Maan Harb, MD, and Alexandra Levine, MD, all from Morristown Medical Center.

Hosted virtually May 15-17, ACC.21, one of the world’s premier meetings for cardiovascular health professionals and researchers, will feature late-breaking clinical research and education across 11 learning pathways in an engaging and interactive forum providing the latest practice-changing updates in care.  Journalists interested in AAC.21 may contact Nicole Napoli, [email protected].

About Heart Care at Atlantic Health System

Morristown Medical Center, the hub of heart care at Atlantic Health System, is one of the top 40 programs in the country for Cardiology & Cardiac Surgery (U.S. News & World Report) and one of America’s 100 Best Hospitals for Cardiac Care (Healthgrades).

Their expert team presents research across the world and is comprised of interventional cardiologists, electrophysiologists, heart failure experts, advanced imagers and cardiac surgeons.

The program also offers specialty care in hypertrophic cardiomyopathy, sports cardiology, cardio-oncology, and heart disease in women. The team works closely with community cardiologists who provide a medical home for patients with heart disease.

Atlantic Health System Heart Care is focused on offering minimally invasive and non-invasive procedures that help patients return to their lives faster. The state’s largest valve replacement/repair program offers valve therapy options for the aortic, mitral, and tricuspid valves, and is helping advance the radial (wrist) approach for coronary procedures streamlining care with the addition of a new lounge for post-procedure recovery.

Morristown Medical Center is home to the largest cardiac surgery and interventional cardiology programs in New Jersey and offers the most up-to-date cardiac imaging technologies available.

About Atlantic Health System 

Atlantic Health System is at the forefront of medicine, setting standards for quality health care in New Jersey, Pennsylvania and the New York metropolitan area. Powered by a workforce of more than 17,000 team members and 4,800 affiliated physicians dedicated to building healthier communities, Atlantic Health System serves more than half of the state of New Jersey including 11 counties and 4.9 million people. The not-for-profit system offers more than 400 sites of care, including seven hospitals: Morristown Medical Center in Morristown, NJ, Overlook Medical Center in Summit, NJ, Newton Medical Center in Newton NJ, Chilton Medical Center in Pompton Plains, NJ, Hackettstown Medical Center in Hackettstown, NJ, Goryeb Children’s Hospital in Morristown, NJ, and Atlantic Rehabilitation Institute in Madison, NJ.

Atlantic Medical Group, comprised of 1,000 physicians and advanced practice providers, represents one of the largest multi-specialty practices in New Jersey and joins Atlantic Accountable Care Organization and Optimus Healthcare Partners as part of Atlantic Alliance, a Clinically Integrated Network of more than 2,500 health care providers throughout northern and central NJ.

Atlantic Health System provides care for the full continuum of health care needs through 16 urgent care centers, Atlantic Visiting Nurse and Atlantic Anywhere Virtual Visits. Facilitating the connection between these services on both land and air is the transportation fleet of Atlantic Mobile Health.

Atlantic Health System leads the Healthcare Transformation Consortium, a partnership of seven regional hospitals and health systems dedicated to improving access and affordability and is a founding member of the PIER Consortium – Partners in Innovation, Education, and Research – a streamlined clinical trial system that will expand access to groundbreaking research across five health systems in the region.

Atlantic Health System has a medical school affiliation with Thomas Jefferson University and is home to the regional campus of the Sidney Kimmel Medical College at Morristown and Overlook Medical Centers and is the official health care partner of the New York Jets.