title: Perceptions of advantages and barriers to radial-access percutaneous coronary intervention in VA cardiac catheterization laboratories.
abstract: OBJECTIVE
  Compared with trans-femoral percutaneous coronary intervention (TFI), trans-radial PCI (TRI) has a lower risk of bleeding, access site complications and hospital costs, and is preferred by patients. However, TRI accounts for a minority of PCIs in the US, and there is currently little research that explores why.
  
  
  METHODS
  We conducted a national survey in February 2013 to assess perceptions of TRI vs. TFI, and barriers to TRI adoption and implementation among interventional cardiologists employed by the US Veterans Health Administration (VHA), and linked these data to site-level TRI annual rates for 2013.
  
  
  RESULTS
  We received 78 completed surveys (32% response rate). Respondents at sites that perform few or no TRIs identified increased radiation exposure as the greatest barrier while at sites that perform a high percentage of TRIs respondents identified the steep learning curve as the greatest barrier. Majorities of survey respondents at all sites rated TRI as superior on 5 of 7 criteria, including patient comfort and bleeding complications, but rated TFI as superior on procedure time and procedure success.
  
  
  CONCLUSIONS
  Even interventional cardiologists at sites that perform few or any TRIs recognized the superiority of TRI for patient comfort and safety, but rated it inferior to TFI on procedure time and technical results. Interventional cardiologists at high-TRI labs rated TRI as equivalent on procedure time and technical results. Efforts to increase TRI adoption and implementation may be more successful if they emphasize that procedure times and technical results depend on achieving proficiency.
authors.affiliation: VA Puget Sound Health Services Research & Development Center of Innovation, US Department of Veterans Affairs, Seattle, WA; Department of Health Services, University of Washington School of Public Health, Seattle, WA. Electronic address: Christian.Helfrich@va.gov.
authors.forename: Christian D
authors.initials: CD
authors.lastname: Helfrich
authors.affiliation: VA Eastern Colorado Health Care System, Denver, CO; Department of Medicine and the Division of Cardiology, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Thomas T
authors.initials: TT
authors.lastname: Tsai
authors.affiliation: Cardiac Catheterization Laboratories, Durham VA Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC.
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
authors.affiliation: VA Puget Sound Health Services Research & Development Center of Innovation, US Department of Veterans Affairs, Seattle, WA.
authors.forename: Jaclyn M
authors.initials: JM
authors.lastname: Lemon
authors.affiliation: VA Puget Sound Health Services Research & Development Center of Innovation, US Department of Veterans Affairs, Seattle, WA.
authors.forename: Evercita C
authors.initials: EC
authors.lastname: Eugenio
authors.affiliation: Department of Cardiology, Jesse Brown VA Medical Center, Chicago, IL; Department of Internal Medicine, Section of Interventional Cardiology, University of Illinois at Chicago, Chicago, IL.
authors.forename: Mladen I
authors.initials: MI
authors.lastname: Vidovich
authors.affiliation: Department of Cardiology, Jesse Brown VA Medical Center, Chicago, IL; Department of Internal Medicine, Section of Interventional Cardiology, University of Illinois at Chicago, Chicago, IL.
authors.forename: Adhir R
authors.initials: AR
authors.lastname: Shroff
authors.affiliation: Department of Cardiology, Jesse Brown VA Medical Center, Chicago, IL.
authors.forename: Bernadette S
authors.initials: BS
authors.lastname: Speiser
authors.affiliation: VA Puget Sound Health Services Research & Development Center of Innovation, US Department of Veterans Affairs, Seattle, WA; Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA.
authors.forename: Chris L
authors.initials: CL
authors.lastname: Bryson
mesh_terms: D006328:Cardiac Catheterization / Q000379:methods; D005263:Femoral Artery / Q000601:surgery*; D006470:Hemorrhage / Q000601:surgery; D006801:Humans; D009203:Myocardial Infarction / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods; D017534:Radial Artery / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Dissemination & implementation; Health services research; Radial artery; Survey research