Fractional Flow Reserve (FFR) is an ideal tool for cardiologists to make the right decision: Dr Nils P Johns.. – ETHealthworld.com

Shahid Akhter, editor, ETHealthworld spoke to Dr Nils P Johnson, Associate Professor of Cardiology, University of Texas, Houston, USA to know more about Fractional Flow Reserve (FFR) and how it impacts the decision making process in Intervention cardiology.

Use of FFR Intervention cardiology One of the biggest challenges that an interventional cardiologist faces is the basic question : which patient needs stents ? It is a technology that is expensive, invasive and is something that stays in the patient's body for the rest of his/her life. So, making that decision in a correct way and quantifiable way is something that cardiology has struggled with for many decades. Fractional Flow Reserve (FFR) provides the best established objective tool for making that decision, so that we can feel confident that 'Yes! this patient needed stent' or 'No! that patient could be simply treated with medicines.' It is a tool that is used everyday while I am working in a cath-lab taking care of patients.

Acceptance of Fractional Flow Reserve (FFR) in the US One of the ways by which this is measured, is by taking the number of Fractional Flow Reserve (FFR) procedures and dividing it by the number of stents. It's a simple ratio, but at least it gives us some understanding of how the amount of Fractional Flow Reserve (FFR) usage has changed over time. It's something that can be compared among countries as well. And countries have published this data. What we see today looking at the US, Australia and countries like Sweden, is that the number is somewhere between 20% and 30% these days. The number though, has really changed in the last 5 years. If you go back, in a lot of those places you will see that, 5 years - 10 years ago it was maybe a third or quarter or less of what it was and so that change, that 4-5 full growth, I think is a sign of how its acceptance has really increased in countries that are able to invest on fractional flow reserve (FFR) as a tool for doctors to make decisions with.

Use of FFR, Clinical evidence and international guidelines It is not just a tool that we as physicians are using to make the correct decisions. It is also a way of validating both the patients and others who are looking at these procedures and said that 'Yes! this was a procedure that was necessary.' So, it's interesting that it has actually entered legal court decisions as well.

Usage of Fractional Flow Reserve (FFR) - Predictability and Precision So, there are a lot of tests that we do in medicine day-to-day. For example, you might check your blood pressure, you might go and have your blood sugar level measured. All of those tests that we do have a certain imprecision to them. If you took your blood pressure and then you took it again you don't get the same number each time. And, one of the important things is to understand how much that number might vary a little bit over time. We then compare Fractional Flow Reserve (FFR) to other tests like Blood Pressure, Blood Sugar for diabetes. We see that FFR actually has the smallest variation compared to those other tests. So, if we say, "Hey! Blood Pressure is a reasonable thing for us to use to make decisions." Blood Cholesterol levels, Blood Sugar levels, Fractional Flow Reserve (FFR) is slightly better than all of those in terms of its precision.

Technological Innovation: Better patient Outcome It's so interesting to see the history of where Fractional Flow Reserve (FFR) started as a great example of the interplay between 'a company that's making a tool' and 'the physicians and researchers developing the evidence for it'. Back when the first company made the Fractional Flow Reserve (FFR) wires in the early 1990s they actually didn't know what was it going to be useful for. The small sensors was made by a company that was into engineering and wanted to make something that no one else was doing before, but they were not certain how it will be useful for the doctor. And, in one of those lucky things that happened in history, the doctors came along and said you know we really need a monitorised sensors, so that we can put down the heart arteries. So, that was the first start and then is this collaboration between physicians and industry. Without either one of those two sides, they wouldn't have known what to do with the product. If the physicians wouldn't have been able to take an idea they had and find the tools to make it a reality. And that's the kind of dynamics that really has continued for 20-30 years with Fractional Flow Reserve (FFR).

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Fractional Flow Reserve (FFR) is an ideal tool for cardiologists to make the right decision: Dr Nils P Johns.. - ETHealthworld.com