Millions Of Americans
Get Unneeded Heart Procedures
By Gene Emery
BOSTON (Reuters) - More than a quarter of the Americans who have heart attacks each year are subjected to expensive, risky and ultimately unnecessary procedures to reopen their clogged arteries, researchers said Wednesday. They said that based on the new findings, about 400,000 to 600,000 Americans each year could easily avoid coronary angiography, the high-tech procedure in which a tube is threaded through an artery into the heart. The procedure costs $20,000 to $25,000 per patient. Commenting on the findings, other experts said heart surgery was a big industry and it was unlikely that hospitals would want to switch to cheaper, less invasive methods -- even if they worked better. Dr. William Boden, chief of medicine at the Upstate New York Veterans Administration Health Care Network in Syracuse, and colleagues said many patients could also avoid angioplasty, in which the clogged arteries are stretched open, usually with a balloon. Boden's team found that the 462 volunteers who had their heart arteries reopened with the balloon technique, or who had bypass surgery, were two and a half times more likely to be dead within a month after their initial heart attack compared to the 458 patients whose doctors used less invasive techniques first. The less invasive techniques include giving patients clot dissolving drugs and using non-surgical tests, such as an exercise stress test, to first assess the degree of damage to the heart.
``We all need to collectively step back and reassess what we're doing here,'' Boden said in a telephone interview. ``Is it wise to subject everybody to the same treatment?'' The study, published in the New England Journal of Medicine, looked at patients with a type of heart attack known as non-Q-wave myocardial infarction, which represents at least 55 percent of all heart attacks. Such attacks tend to be milder than other types. Boden estimated that half of that 55 percent should not need aggressive treatment. Boden's is the fourth large study of heart attack patients to conclude that aggressive treatment does not save lives and may, in fact, carry greater risks.
Yet none of the previous findings have radically altered the way doctors treat heart attack patients, Dr. Richard Lange and Dr. David Hillis of the University of Texas Southwestern Medical Center in Dallas wrote in a commentary in the journal. One reason is that a doctor who avoids angiography and angioplasty may be accused of giving lackluster treatment. Another, according to Lange and Hillis, is that many doctors still believe that all heart attack patients need aggressive treatment ``despite the absence of scientific support for such an approach.''
In addition, they said, there are lots of doctors trained in the aggressive techniques, plenty of expensive equipment to perform them, and plenty of money to be made if those techniques are used. ``This is clearly a big industry,'' said Boden, who also predicted that neither this study nor past research was going to steer doctors away from the aggressive treatments. ``People tend to accept what they want to believe in and reject what they don't,'' said Boden. ``Ultimately what will probably happen is (insurance companies) and HMOs (health maintenance organizations) are going to say, 'We're not going to reimburse you for a coronary angiogram or angioplasty' unless there's better evidence that it's needed.'' The researchers stressed that angiography is clearly helpful in some cases. Lange and Hillis said people who develop chest pain even after being put on drug therapy, for example, can clearly benefit from angiography, angioplasty and bypass surgery. But treatments should be guided by the results of medical studies, they said, rather than by doctors' preferences or other, nonmedical incentives.

Sightings HomePage