Studies Question Effectiveness of Artery-Opening Operations

Studies Question Effectiveness of Artery-Opening Operations

News and Commentary

Studies Question Effectiveness of Artery-Opening Operations - A new and emerging understanding of how heart attacks occur indicates that increasingly popular aggressive treatments may be doing little or nothing to prevent them. [New York Times Healthcare News]

This article helps shine some light on the Tenet case of Redding cardiologists who have been accused of performing hundreds of unnecessary bypass surgeries. In Redding, the cardiology center aggressively marketed heart surgery as preventive care. This article cites studies of the ineffectiveness of bypasses and stents as preventive measures and describes how cardiologists end up putting their financial interests above their patients’ interests.

“Dr. David Hillis, an interventional cardiologist at the University of Texas Southwestern Medical Center in Dallas, explained: ‘If you’re an invasive cardiologist and Joe Smith, the local internist, is sending you patients, and if you tell them they don’t need the procedure, pretty soon Joe Smith doesn’t send patients anymore. Sometimes you can talk yourself into doing it even though in your heart of hearts you don’t think it’s right.’

Dr. Topol said a patient typically goes to a cardiologist with a vague complaint like indigestion or shortness of breath, or because a scan of the heart indicated calcium deposits — a sign of atherosclerosis, or buildup of plaque. The cardiologist puts the patient in the cardiac catheterization room, examining the arteries with an angiogram. Since most people who are middle-aged and older have atherosclerosis, the angiogram will more often than not show a narrowing. Inevitably, the patient gets a stent.”

According to the article, only 20% of heart patients follow advice for preventing heart attack: lowering cholesterol, lowering blood pressure and giving up smoking. There is a lot of room for disease management to help patients have better outcomes.

To learn about potential savings from reducing unnecessary heart surgery, read the studies done by Dartmouth about waste in Medicare.