ACC.21: Digital app should replace stent cards as a patient PCI record

Fewer than half (48%) of patients undergoing percutaneous coronary intervention (PCI) still had the provided stent card with them when surveyed at a later date, according to research to be presented at the American College of Cardiology’s 70th Annual Scientific Session (ACC.21, 15–17 May, virtual).

According to the authors of the study, the findings call into question the use of stent cards as an effective means of conveying critical information related to their procedure.

A stent card is a wallet-sized cardboard document with the type, size, date, and vessel for the coronary stent. A smartphone app, or other digital tool, may be a more appropriate means of providing the information, the researchers suggest.

The study, entitled, “Knowledge retention after percutaneous coronary intervention,” was carried out by researchers at Atlantic Health System’s Morristown Medical Center (Morristown, USA) and the findings are to be presented as a moderated poster at ACC.21. The objective of the research 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.

Researchers claimed that, 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.

“Stent design has advanced significantly since the mid-1990s, with the evolution of new polymers and advanced drug-eluting stents,” said the study’s lead author Jordan G Safirstein, director of transradial catheterization for Morristown Medical Center, Morristown, USA.

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 versus drug-eluting). These are all critical factors in our decision making about new stenting.”

For the study, 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 carried out from 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. Researchers found 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 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. 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 mobile 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 behavioural 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 healthcare provider.”

“The vast majority of patients would use their phone for stent device-related purposes,” said 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.”