In this episode, guest host Dr. Robert Ryu interviews Dr. Warren Clements and Dr. Premal Trivedi about the current state of IVC filter retrievals, obstacles to increasing retrieval rates, and their experiences with implementing programs to increase IVC filter retrieval rates within their respective healthcare systems.
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SHOW NOTES
Dr. Clements begins the discussion by giving an overview of his recent paper published in CVIR, which explores a novel multidisciplinary approach to IVC filter retrievals. He introduces key features of the Australian healthcare system that contribute to their strengths and challenges with IVC filter retrievals. Dr. Clements emphasizes the positive correlation between maintaining an active database of all IVC filter patients and increased retrieval rates. He discusses the limitations of their previous approach towards IVC filter retrievals, which relied on referring physicians and an automatic retrieval referral system. This passive model posed issues with timing and led to a lower retrieval rate. He also highlights the differences in governmental oversight and filter utilization between Australia and the US, emphasizing the importance of aiming for a 100% retrieval rate. The new approach at his hospital involves a multidisciplinary team, which has resulted in retrieval rates going from 53% to 74% .
Next, Dr. Trivedi discusses his recent paper, which is also focused on quality improvement surrounding IVC filter retrieval. He describes his health system’s previous passive approach that relied on a follow-up list of all patients with IVC filters. The list was checked monthly, and letters were sent to patients providing the status of their filters along with educational material. However, since 2016, they have adopted an active methodology, which relies on the IR team actively evaluating the list of patients with an IVC filter and verifying whether retrieval is appropriate in each case. This active approach engages referring doctors and schedules retrievals as needed. Implementing this new methodology has resulted in an increase in IVC retrieval rates from 49% to 61%.
The doctors discuss the significant number of filters placed before 2010 that still need to be retrieved. They emphasize the need for a central dedicated team to take responsibility for filter follow-up and retrieval, and they highlight potential role of AI in automating the process and addressing issues related to patients who are lost to follow-up.
Finally, they discuss the future of filter retrieval. Both Dr. Clements and Dr. Trivedi stress the importance of knowing the IVC retrieval rate to set goals accordingly. Dr. Clements shares his team's goal of reducing median dwell time to less than 150 days and the benefits of establishing a national registry. Dr. Trivedi emphasizes the need for incremental goals and celebrating small wins on the path towards increasing overall filter retrieval rates. He also discusses the importance of aligning economic and health incentives and leveraging existing AI technology. They all agree that achieving a 100% filter retrieval rate requires a collaborative effort within a multidisciplinary team.
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RESOURCES
“Improving the rate of inferior vena cava filter retrieval through multidisciplinary engagement” by Clements et al:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9958400/
“Inferior Vena Cava Filter Retrieval Rates Associated With Passive and Active Surveillance Strategies Adopted by Implanting Physicians” By Trivedi and Ryu et al:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2802524
BackTable Vascular & Interventional