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Veracity in consenting for coronary angiography: a case series investigation

Session Poster Session 1

Speaker Howard Thomas Blanchard

Congress : EuroHeartCare 2019

  • Topic : cardiovascular nursing and allied professions
  • Sub-topic : Cardiovascular Nursing and Allied Professions - Other
  • Session type : Poster Session
  • FP Number : P180

Authors : HT Blanchard (Boston,US), DL Carroll (Boston,US)

Authors:
HT Blanchard1 , DL Carroll1 , 1Massachusetts General Hospital - Boston - United States of America ,

Citation:

Introduction: Coronary angiography (CORS) can be a precursor to medication optimization, percutaneous coronary intervention (PCI), or a coronary artery by-pass graft (CABG) for Coronary Artery Disease (CAD). CORS requires vascular access, plus steps that allow PCI to be completed as an extension of the CORS procedure. Three patients were consented for coronary angiography and possible PCI (CORS +/-), but were brought out of the procedure room after completion of CORS. This case series depict a subset of the population that consented for CORS +/- whose anatomy indicates consideration of CABG.

The Patients Prior to CORS, patient one was living with hyperlipidemia (HLD) and hypertension (HTN), recently suffering exertional chest pain that eased with rest.  CT angiography indicated blockage in coronary arteries.  CORS confirmed significant CAD ending the procedure. The patient was referred to a surgeon for informed consent for CABG. Patient two had a history of HTN, myocardial infarction (MI) and CAD. The patient had an abnormal electrocardiogram during a physical exam that led to a stress test and echocardiogram.  CORS revealed significant CAD prompting an end to the procedure. There was a discussion with the catherization cardiologist, and a decision was made in favor of PCI over CABG.  Patient three had a history of MI, HTN, HLD and CAD. With CORS finding significant CAD, the referring cardiologist was contacted.  The referring cardiologist spoke with the patient regarding the need to follow-up with a surgeon for CABG.

Discussion Ending a procedure after the diagnostic phase and providing a patient time to decide among the possible options of lifestyle changes, improved medical management, PCI or CABG allow a shared review before decision making. Consenting a patient for CORS +/- is both appropriate and expedient for proceeding forward to intervention after a patient has CORS for suspected CAD that was found amenable to PCI.  This process has been described as a pro forma for PCI intervention.  However, CORS defines several possible care choices, including PCI, either during the same procedure or to follow at a later date. For the three patients described, having coronary anatomy possibly needing an intervention other than PCI, there were three diverse experiences in how they were informed of their choices and their actual participation in decision making for informed consent.

Implications for Practice: One of the hallmarks of evidence-based practice is the consideration of the preferences of the patient. Nurses can support patient informed decision making by ensuring patients understand the benefits of various treatment options that allows for clarity of decisions regarding treatment choice. It is important that nurses understand the patient-important outcome, and to advocate the patient perspective when they are faced with a new consent decision.



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