Emory Practical Intervention Course Southeastern Consortium 2018

Final Outcomes Report

Overview: For its 37th anniversary, EPIC‐SEC took place April 19‐21, 2018 at the Emory Conference Center Hotel in Atlanta, Georgia. The conference delivered cutting‐edge updates on the latest strategies in coronary, structural heart and peripheral vascular imaging, physiology, and intervention. Distinguished faculty from 21 academic medical institutions, along with dozens of other key opinion leaders shared their wisdom and insights through live case demonstrations, lectures, presentations, panel discussions of complex cases, and debates.

Credit Awarded: The Academy for Continued Healthcare Learning (ACHL) certified this live activity for physicians by designating a maximum of 25 AMA PRA Category 1 Credits™.

Intended Audience: EPIC-SEC was designed for interventional cardiologists, cardiac and vascular surgeons, nurse practitioners and physician assistants, interventional radiologists and other healthcare professionals interested in the optimal practice of interventional and structural cardiovascular medicine.

Program Information

www.EPICsec.org

Participation526 Program Participants; 185 Certificates Issued

Practicing Type44% Physicians, 12% Fellows, 22% Allied Health

Learning Objectives

95% of learners strongly agree or agree that all learning objectives were met, with an average rating of 3.60/4.00

Faculty

All EPIC SEC faculty were highly rated across all four areas, with an average rating of 3.90

Patient Outcomes

80% indicated participation in the activity will impact their patient outcomes

Executive Summary

Level 1: ParticipationParticipants Certificates

526 183

44%

12%

22%

22%

Participation by Clinician Type

Physicians

Fellows

Allied Health

Industry

Participant Type Number

Physician 230

Fellow 64

Allied Health 114

Industry 118

Total 526

Level 2: Learning ObjectivesPlease rate the following objectives to indicate if you are better able to: Analysis of Respondents

Rating scale: 4=Strongly Agree;

1=Strongly Disagree

Recognize the efficiency of novel techniques and review current state-of-the-art approaches to the optimal practice of coronary, structural, and peripheral interventions 3.75

Explain the improvement in clinical outcomes following optimal percutaneous and surgical management of complex coronary artery disease, including chronic total inclusions, cardiogenic shock, and cardiac arrest

3.69

Discuss the next generation drug-eluting stents and drug-eluting balloons, and how they can prevent the leading causes of stent failure, which are stent thrombosis, stent restenosis, and neoatherosclerosis

3.56

Review safety and efficacy of transcatheter aortic, mitral, and tricuspid valve replacements and repairs in high- and intermediate-risk patients 3.63

Evaluate the prevalence of microvascular and vasospastic disease and describe their novel pharmacologic interventions 3.52

N=177

Level 2: Learning Objectives (cont)

All learning objectives were met, with an average rating of 3.60/4.00

Please rate the following objectives to indicate if you are better able to: Analysis of RespondentsRating scale:

4=Strongly Agree; 1=Strongly Disagree

Appraise the safety and efficacy of ventricular assist devices in heart failure 3.56Summarize novel catheter based treatments of cardiac arrhythmias 3.46Explain the indications for invasive physiologic (FFR, iFR) and imaging assessments (IVUS, OCT) of lesion severity to determine optimal revascularization strategies 3.70

Review developments in therapies related to left atrial appendage occlusion 3.54Describe the mechanisms of action and clinical applicability of lipid-lowering agents for primary or secondary prevention of coronary artery disease 3.57

N=177

Level 2: Satisfaction

All aspects of the activity were highly rated at 3.65 or higher.

Overall Evaluation Analysis of Respondents

Rating scale: 4=Excellent; 1=Poor

Quality of educational content 3.88

Effectiveness of teaching method used 3.82

Time allotted for presentation of information 3.65

N=182

100% of learners would recommend this activity to a colleague.

Level 2: SatisfactionPlease rate the importance of your reasons for participating in this educational activity

Analysis of Respondents

Rating scale: 4=Extremely; 1=Not at all

Topics 3.73

CME/CE credit 3.29

Faculty reputations 3.49

Interaction with colleagues 3.44

N=180

Level 2: Faculty Evaluation

All EPIC-SEC faculty were highly rated across all four areas, with an average rating of 3.90

Rating scale: 4=Excellent;

1=Poor

Ability to effectively convey subject

matter

Ability to present scientifically

rigorous information

Expertise on the subject matter

Ability to adjust to the knowledge &

experience level of audience

All EPIC-SEC Faculty 3.89 3.90 3.92 3.90

N=173

Objectivity & Balance

Activity was perceived as objective, balanced and non-biased.

1%

99%

Did you perceive any bias?

Yes No

N=180

Levels 3-5: Activity Impact

This activity was highly effective, with 80% of attendees indicating participation in this activity will improve their patients’ outcomes.

Self-reported activity impact Yes No No change

Increase knowledge 88% 0% 12%

Increase competence 83% 3% 14%

Improve performance 78% 2% 20%

Improve patient outcomes 80% 3% 17%

N=178; see comments in appendix

Levels 3-4: Activity ImpactSelf-reported increase in knowledge• Timely referral • Exposure to new devices and techniques • Live case explanation in real time • New radical access approach • PCI, TAVR• Learned about orbital atherectomy • Address in TAVR• Relevant to referral for procedure

• MVR, TAVR, Afib, ACS, and SCAD • Learned guidelines • Structural heart diseases are called structural heart access

options• Intravascular imaging• New ideas for treatment• Use of mechanic support• New trial techniques

Self-reported increase in competence • AVC • Use of mechanic support• More comfortable with Intracoronary physiology • Intravascular imaging• Talk through allows me to anticipate needs• Start with hemodynamic support then proceed to

complication

• Exposure to new devices and techniques • Radial ultrasound• Relevant to referral for procedure • Gave me a broader scope of information • Helped me to know what to expect in certain high risk PCI

solutions• PCI, TAVR• Transeptal

Levels 3-4: Activity ImpactSelf-reported improvement in performance

• Wider knowledge base • AVC• Use of mechanic support • More comfortable with Intracoronary Imaging• Intravascular imaging • Anticipation allows me to provide equipment faster

• Exposure to new devices and techniques • Relevant to referral for procedure • More prompt support • Helped me to be prepared • Continue to learn and practice • PCI

Self-reported improvement in patient outcomes

• Understanding CDT benefit • PCI complications• Use of mechanic support • Follow new guidelines • Awareness of SCAD, reduced bleeding • Change to femoral access in face of complications

• Intravascular imaging • Higher patient outcomes from procedure knowledge• Exposure to new devices and techniques• Relevant to referral for procedure • Better physician knowledge• By improving patient selection • Better tech with improved results• ACS syndrome

Levels 3-4: Patient ImpactPlease identify two changes you will make in your practice or professional activities as a result of attending EPIC-SEC 2018: • Apply clinical knowledge with new and improved test• Emphasize excellent imaging for treatment• Lower threshold to transfer to other facilities for higher level

of care• Use of POT technique for bifurcation stenting • Antiplatelets• Less aggressive treatment of lower risk TAVR• Trancoval access• Knowledge based diagnostic • Better evaluate for structural heart disease• Initiate PE program • Will use 14Fr Cook Schemes for Indwellip Impella• Use IVUS to confirm re-entry after crossing CTO • Improved ability to recognize best practices • Adjustment of the TAVR technique • Will apply more intravascular imaging • Be more aware of anti coagulation/antiplatelet therapies

for my patients• Consider RP Impella earlier for RU • Increase use of IVUS during PCI

• Use of IMPELLA in shock • Better use of AVC criteria • More use of mechanical support• Left main coronary PCI • Try distal radial access• Will use more intracoronary physiology to guide

interventions, will pay more attention to AVC• More emphasis on preventers of Lipids • Be more aware of SCAD• As a RN it has increased my understanding of the different

procedures the patients undergo • Antiplatelet treatment coronary artery disease• Participate in FFR, IFR procedures with better understanding • Patient with small SOV that needs TAVR being evaluated by

a colleague • Improved strategies for bifurcation stenting • Engage more with the physicians to better understand

procedures performed • Earlier support with STEMI with shock • Strategies to proceed to more complex cases

Levels 3-4: Patient Impact (cont)Please identify two changes you will make in your practice or professional activities as a result of attending EPIC-SEC 2018:

• More effective educator to my patients• Weigh complications vs efficiency • Use of Impella aggressively in shock points• Anticoagulants• Electrified guide wires• Management decisions• Better guide patients to appropriate management • Will adopt Trans Carved access for TAVR• Have even lower CDC levels for my patients • More aggressive lipid lowering drug use• Treatment of STEMI in patient with MVD• More from IFK to FFR• Will adopt strategies to reduce bleeding in ACS patients with

AFIB on anticoagulation • More precision Quantities PET imaging • Imaging for Ischemic VSD-CT • Management of cardiogenic shock • Review certain procedures prior to scrubbing them ex.

Lampoon or Basilica • Dosing of triple/double blood thinness

• Use more physiology in cath lab• Learn to scrub in PCI procedures• Card Team standardized approach• Study more on IT and AI• Will explore more coronary physiology• Understand issues relating to patient complications• Doing more TAVR procedures under conscious sedater• Institute PE program at our institution• Peripheral disease focus • Thinking of more ways to care for my patients• Contrast saving devices• Improve collaboration with colleges• ECMO for massive pulm embolus-hemodynamic collapse• Learn more about Mitral Valves• Try distal radial access for cath• More CABE surgery vs. PCI • Screen all SCAD for FMD• Assessment of flow significant coronary lesions

noninvasively • Mitral trans-catheter therapy

Topics of Interest What topic areas would you like to see at future conferences? • Practical modalities for arrythmia care and heart failure • Define candidates for hemodynamic support• More peripheral taped cases• I think lectures were balanced well • More on the use of echocardiography for structural

interventions• More detailed imaging lectures• ECMO in cardia arrest • Live PFO closure, live atrial ocular device• EHR and clinical outcomes • Treatment of the under expanded start laser v. roto• Proposed Medicare changes involving cardiology• Very organized, structural tract content very good.• More on IT issues and application to reduce cost• Stem cell research and results• Same as this year• Advances in calcium score measurement and clinical

applications• Structural technique description

• More nurse and tech relationships with Dr • Communication improvements and more team approach

toward practice and procedures• More structure heart on display moving forward to

accommodate out-time• More research on use of Impella frequency• More valvular and structural. More hemodynamic support in

cardiogenic shock• Viv TAVR, optimizing outcomes, bioprosthetic valve fracture• Review of the new ACC/AHA Cholesterol Guidelines• Institutions discuss QI initiatives• Planning a successful PCI and STEMI program• Leadership and cardiovascular business• In depth explanation and reasons for pacemakers and ICD’s• Coronary Cases• Management of shock in STEMI patients• HOCM septal ablations• Cardiac Neurology

General Comments

• Very good course, I try to get here every year • Excellent program• Excellent conference I come every year• Case reviews during lunch were excellent!• Very well organized, best EPIC yet• Excellent meeting as always• This is a great learning review I really love the way I

leave energized and enthusiastic about cardiology• Wonderful course, Thank you this is my 20th year and I'll be

back next year• Expand prevention Symposium to half day• RN/Tec symposium was the best addition to EPIC!!! Thank

You• Very nice course, maybe doing more live cases next year

would be beneficial• I benefited from all topics, very good conference with lots of

pertinent information, more specific sessions for apps would be beneficial

• Great conference, was honored and excited to participate

• Been here for several years and this one was the best, it gets better and better!

• Very pleasant staff, excellent speakers• Very informative, great conference• Very good presentations• Excellent conference, well planned.• Love EPIC!!• Great meeting! Keep it up.• Lazarus cases are fantastic and unique to EPIC, a highlight

of the course for me• Excellent and interesting topics discussed.• Some presentations needed a little bit more time• Conducive to include ACC as speaker on direction of ACC.

Increase marking to APRNs/PAs and increase topics specific to Advanced practitioners and how they can facilitate and improve outcomes in complex CV patients. Also, consider poster presentations for FITs/APPs on case studies. Great Course!

• Great times for each speaker, completely engaged and not tiresome

Contact InformationSara Brykalski Director, Accreditation and Educational Effectiveness Academy for Continued Healthcare Learning (ACHL)

E: sbrykalski@achlcme.orgP: 773-714-0705 ext. 228

Kylie ShannonProgram Coordinator, EPIC-SECEmory University Hospital, Division of Cardiology

E: kylie.shannon@emory.eduP: 404-712-1981