The majority of angioplasties are performed on patients with stable coronary artery disease.
And yet studies have shown that angioplasties do not have a greater benefit than medication management and lifestyle changes in this demographic, and expose patients to the risk of an interventional procedure.
The NY Times cites Miami cardiologist Michael Ozner who says, “We’ve extended the indications for surgical angioplasty and stent placement without any data to support the procedures in the vast majority of patients “” stable patients with blockages in their arteries.”
Regular readers of this blog know that money is the major reason for this.
Invasive cardiac treatments, like bypass surgery and angioplasty, cost about $60 billion annually, and are covered by insurance plans despite the questionable mortality benefit they have in patients with stable, asymptomatic heart disease. Preventive treatment, like lifestyle modification and stress management, are poorly reimbursed, if at all.
More medical care isn’t necessarily better. And this is especially relevant during these difficult economic times where we’re continually searching to control health spending.
Related posts:
- Slate on angioplasty
- Healthy heart scan
- Are doctors skipping the stress test?
- Should heart disease screening tests be covered by insurance?
- Don’t have a heart attack on the weekends
- My take: Preventive care, Atlas, $$$, Grady bailout
- Does preventive medicine save money or cost more in the long run?
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I would be interested to know if in these trials comparing lifestyle mod to stent placement whether the “lifestyle” group receives a lot of coaching and encouragement.
Often in trial situations the participants are followed up frequently and make a lot of effort to change. As you point out, in real life you get a couple of peices of paper shoved at you and sent on your way — with predictable results.
So my question would be, is the interventionist procedure more effective when compared to the miserable level of compliance you’d see in real life, as compared to compliance in a group of closely coached patients.
The other dirty secret of cardiology is that half of people with acute myocardial infarction do not have any significant narrowing of their coronaries prior to the event.
The old attage from Watergate holds, “Follow the money.”
Thank-you for pointing out this article.
there must be countless overtreatments and “risk-reducing” invasive procedures that are taken for granted by medical institutions even while risking negative outcomes on the patient victims. Other such unnecessary procedures still unquestioned in medical establishments are the castrations and hysterectomies performed on healthy women. Sadly, at worst, these are often performed without prior permission, and at best, under coercion.
What are some of the other unquestioningly performed but often unnecessary procedures to be watchful for?
In light of recent reports, elective c-sections might be a good area to look at WRT cost control. Pregnant women who wish to schedule their child’s birth for their own convenience ought to have to pony up for the privilege.
Many people are surprised to learn that invasive treatment with angioplasty, stents and bypass fail to reduce mortality or heart attacks, when compared to conservative medical treatment with drugs.
Dr Richard Shemin writes in Circulation in 2008,”Survival advantages of stent therapy for coronary artery disease over medical therapy have not been a consistent result in clinical trials.”
A five year trial published in 2005 comparing stenting to CABG for multivessel disease shows no difference in mortality.
Conventional drugs used for medical treatment of heart disease include: Beta Blockers such as Inderal, calcium channel blockers include Cardizem, Procardia, and Norvasc. Nitrates such as Isordil, Sorbitrate, Cardilate, Dilatrate, and Peritrate. Nitroglycerine skin patches include Minitran, Nitro-Dur and Transderm-Nitro. Diuretics and ACE inhibitors are used.
Why does medical therapy work?
Medical therapy reduces the oxygen demand of the heart muscle and allows time for the heart to develop microscopic collateral vessels which provides blood flow around the blocked arteries.
To read more:
Cardiac Bypass, Angioplasty and Stenting by Jeffrey Dach MD
Jeffrey Dach MD
4700 Sheridan Suite T
Hollywood Florida 33021
954-983-1443
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