Cardiology: Are We Making Things Worse?

Heart doctors do what they get paid to do:

Heart LogoCoronary artery bypass surgery, angioplasty and the placement of drug-coated stents – cost about $60 billion a year in the United States. Though they are not known to prevent heart attacks or coronary mortality in most patients, they are covered by insurance. Counseling patients about diet, exercise and stress management – which is relatively inexpensive and has been proved to be life-extending – is rarely reimbursed.

However, what they don't get paid to do is often better for patients:

Putting stents in [relatively healthy] patients is no more protective than following a heart-healthy lifestyle and taking medication and, if necessary, nutritional supplements to reduce cardiac risk. The studies have also shown that stents sometimes make matters worse by increasing the chance that a dangerous clot will form in a coronary artery.

Here's the new theory:

Most heart attacks do not occur because an artery is closed by a large plaque. Rather, a relatively small, unstable plaque ruptures and attracts inflammatory cells and coagulating agents, leading to an artery-blocking clot.

In most Americans middle age and older, small plaques are ubiquitous in coronary arteries and there is no surgical way to treat them all.

Full piece is from Jane Brody.

Comments (5)

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  1. Marty says:

    This may be one of the reasons the United States spends so much more than other countries without producing notably better results.

  2. Jerry Mason says:

    Thanks for this post. It was a real eye opener.

  3. Joe S. says:

    What you didn’t emphasize enough is that these procedures often make patients worse off.

  4. Linda says:

    Gee, putting stents in relatively healthy people doesn’t help. Wonder how many times that happens? Unfortunately neither Ms. Brody nor the physician she references says. They just blame insurance and say that you can exercise your way to health.

    There is evidence that people enrolled in coronary artery disease studies are less sick than average. This means that in studies they are less likely to have poor outcomes even with no intervention. Current thinking recommends medical management for people who are stable with low risk. Otherwise, intervention definitely helps by reducing mortality and morbidity.

    Finally, it is simply not true that the US spends more and has worse results. For example, it does much better in cancer survival, infant mortality by birthweight, population blood pressure control, on dialysis, on all sorts of measures of preventive care, and on hospital errors. Assuming, of course, that spending is adequately measured in countries that control provider reimbursement–which it isn’t.

  5. John Goodman says:

    This is from Jason Shafrin:

    A new book by Dr. Michael Ozner takes on the cardiovascular surgery industry head-on. The aptly titled Great American Heart Hoax claims that although insurers pay $60 billion per year invasive cardiovascular surgery, 70%-90% of these procedures are unnecessary.

    Full review here: