2023-04-19 23:05:11
PARIS, April 19, 2023 (APMnews) – The procedures for implementing the reform of interventional cardiology activity authorizations are explained in an instruction published in the Official Bulletin (BO) health-social protection-solidarity of Monday April 17 , which insists on the need to take into account the territorial organization of this activity and cooperation between the players in the sector.
The new decrees and orders on interventional cardiology activities, which define new criteria with several levels of activity and specify the thresholds for the number of interventions, were published a year ago (cf. dispatch from 03/18/2022 at 11:47 et dispatch from 10/12/2021 at 4:48 p.m.). The instruction of April 6 published in the BO aims to specify the implementation of this reform, while establishments have until June 1, 2023 to request new authorizations for this activity.
This reform led to the redefinition of three types of activity with different levels of gradation, it will be recalled: interventional rhythmology with four “mentions”; congenital heart diseases excluding rhythmology (two mentions), which include children but also patients who have become adults suffering from these pathologies; ischemic and structural heart disease in adults.
The gradation system that has been established “aims to take into account the differentiated complexity of the techniques and the requirements to be associated with them in terms of quality and safety and registration in the cardiology sectors of the territories”, comments the management. general provision of care (DGOS) in the instruction. “With a view to improving the supply of care, the regulation of this activity must respond to two major challenges, which are the improvement of the territorial organization of care and the strengthening of the relevance of practices, of the quality and safety of care”.
It is underlined that “the identification within the regional health scheme (SRS) of the different modalities and mentions of interventional activity under medical imaging in cardiology will contribute to ensuring the visibility and readability of the territory’s healthcare offer” .
These “integrated centers” of interventional rhythmology
Concerning interventional rhythmology, the instruction evokes the interest of a structuring in “integrated” centers for on the one hand, to have a “sufficient number of patients” and on the other hand, “to guarantee the quality and the safety of the care and the sizing of technical platforms”. She insists on the need to pay “particular attention” to “cooperation and organization between the players in the sector”.
In addition, “taking into account medical demography, it is useful to promote cooperation between health establishments allowing trained cardiologists, practicing in unauthorized establishments, to perform acts falling within the scope of the authorization within authorized establishments, if necessary, by setting up local medical teams.”
With regard to congenital heart disease, this activity is growing due to an improvement in the life expectancy of these patients, which leads to an increase in the number of patients followed. It is stressed that there must be a “close liaison, face-to-face or by convention”, between interventional specialists and doctors competent in pediatric and congenital cardiology and pediatric cardiac surgeons.
Round-the-clock care for emergency angioplasties and territorial coverage
For ischemic and structural heart disease in adults, a significant part of angioplasty activity is devoted to the emergency management of acute coronary syndrome. “Thus, a permanence of care (opening H24) is required for any holder of the authorization.”
In addition, the instruction mentions the need to define a “territorial network” for the care of these patients in an emergency. It is therefore necessary to establish an organizational agreement between each of the health establishments receiving emergencies and an establishment authorized to practice this interventional activity.
This is also part of “a complete care offer” including pre-hospital emergency response channels (Samu), intensive care units in cardiology (Usic), cardiology services, rehabilitation as well as the follow-up of patients at home.
“In this respect, it is important to develop coordination between the interventional cardiology structures and the attending physicians, in particular for the management downstream of the interventional act.”
For interventional rhythmology activities and interventional treatment of congenital heart disease excluding rhythmology, although they are most often scheduled, it is nevertheless “required” to have operational on-call duty.
In addition, “for ischemic and structural heart disease in adults and for interventional rhythmology, mentions B and C, a doctor specialized in anesthesia-resuscitation or intensive care resuscitation must be able to intervene at any time during the performance of the act in order to participate in the management of the complications involving the vital prognosis which might arise.
For the safety of both patients and staff, establishments must “ensure the assistance of a medical physicist as part of the process of optimizing exposure to ionizing radiation”.
Insofar as these interventional cardiology activities are expected to increase in the future due, on the one hand, to the aging of the population and, on the other hand, to probable enlargements of indications, the instruction mentions the need to take an interest to different indicators (epidemiological, description of the offer, use of care).
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