Cardiologists are rethinking their overuse of angioplasty – a procedure to unclog heart arteries. What’s behind it? Soaring health care costs. And fear that the FDA and insurance companies will soon clamp down on the costly treatment.
So doctors are doing their own research in an effort to self-regulate. And it could lead to less-invasive procedures for many patients.
One study was done at St. Luke’s Hospital in Kansas City, Missouri. It was part of an American College of Cardiology project. Data from more than 1,000 U.S. hospitals was used. More than 500,000 cases were reviewed. Results ran in the Journal of the American Medical Association (JAMA).
The findings: One in nine non-emergency angioplasties may be inappropriate. More than half of them are done on patients who don’t even have symptoms.
But that’s not even the biggest problem. It doesn’t actually work.
With angioplasty, a balloon is inserted into the artery. It’s slowly inflated. Then it’s deflated and replaced with a small metal stent. The stent is supposed to keep the artery open. But an earlier government study found that arteries with stents re-clog as quickly as arteries without them. Not only that, angioplasty can have serious side effects. These include allergic reactions, blood clots, chest pains, irregular heart rates, and heart attacks.
About 600,000 Americans have the procedure every year. Each one costs about $20,000. Diet, exercise, and medication can be just as effective. Yet most cardiologists push for the invasive surgical treatment.
The American College of Cardiology study is just the latest warning. Government authorities have already been investigating heart specialists across the country. And some hospitals are being sued.
Let’s take a closer look at Coronary Artery Disease (CAD). It occurs when plaque builds up in the arteries. That blocks the blood supply to the heart. To “fix” the problem, most cardiologists offer two options: Bypass surgery to redirect the blood flow. Or angioplasty.
Sometimes, the patient has no choice. If, for example, he is on the verge of a heart attack. The study found that about 75% of angioplasties are done in emergency situations. It also found that 99% of those angioplasties are appropriate. And they do save lives.
But in non-emergency cases, the procedure does little to prevent death or a heart attack. So thousands of patients are putting their health at risk unnecessarily. They’re straining their own finances. And it’s costing the government. Medicare shelled out $25.7 billion for stent implants in just six years.
Another study – the “COURAGE Trial” – was conducted by the U.S. Department of Veterans Affairs. It looked at over 2,000 patients. They all had at least one partially clogged artery. They also had limited blood flow to the heart.
All of the patients received aggressive generic drug therapy. Half of them also underwent angioplasty. After following the patients for nearly five years, the researchers found that there was no significant difference in their outcomes. Whether the patients had the procedure or not, it didn’t affect the rate of deaths and heart attacks.
The results of this study were released in 2007. So why is the procedure still so popular?
Because it’s a big money-maker for the biomedical industry. To the tune of $12 billion a year. And doctors get a piece of that pie. The more procedures they do, the more they benefit financially.
“I’ve certainly seen many patients that when I looked at their medical records it was hard to consider their angioplasty medically justified,” said Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic. “We do live in a system with a fee for service type reimbursement. That tends to encourage high cost medical procedures.”
Doctors on Trial
Dr. Mark Midei, a Maryland cardiologist, was actually honored by Abbott Laboratories. They threw a $1,407 pig roast to celebrate his record-setting accomplishment: He implanted 30 of the company’s stents in a single day!
Not surprisingly, Dr. Midei has been accused of doing hundreds of unnecessary procedures. He’s also accused of falsifying patient records to justify the surgeries. As a result, he is facing multiple lawsuits. And earlier this month, the Maryland Board of Physicians revoked his medical license.
“Dr. Midei’s violations were repeated and serious,” they wrote. “They unnecessarily exposed his patients to the risk of harm. They increased the cost of the patients’ medical care.”
But don’t feel too sorry for Dr. Midei. Though he can no longer operate on patients, Abbott Labs hired him as a sales consultant.
- A doctor in Tennessee is under investigation by the U.S. Justice Department. He allegedly conspired with a radiologist and two hospitals to do unnecessary angioplasties and other procedures.
- An Austin doctor was under investigation by the Texas Medical Board for allegedly doing as many as 30 unnecessary angioplasties.
- Two doctors in Pittsburgh were forced to give up staff privileges after doing 141 questionable angioplasties.
- In Greensburg, Pennsylvania, Excela Health, a large healthcare provider, is looking at 72 lawsuits. They were filed after 192 patients were informed that they may have undergone unnecessary heart surgeries at Excela hospitals.
What This Means for You
If you have CAD, do your homework. Talk to your doctor about alternatives to surgery. If he insists that angioplasty or bypass is necessary, do a little more checking. One thing you want to find out is how many surgeries he does every year. If the number seems uncommonly high, it may be a sign that he’s motivated more by dollars than what’s best for you. Remember that you can always ask for a second opinion.
Remember, too, that you can do a lot for your overall heart health with diet and exercise. Good fats found in nuts like walnuts and almonds are good for you. So are the Omega-3 fats found in lean protein like wild-caught fish. And you should be eating a wide variety of fruits and vegetables. (Beets, in particular, have recently been shown in studies to be very beneficial for heart health.)
Exercise relieves stress. So stay active. One thing to consider is yoga. It is often recommended for people with heart disease. It has been shown to improve blood pressure, cholesterol, and blood sugar levels. It could also help prevent blood clots and heart attacks. Get your doctor’s okay, of course, before starting on any exercise program.
To your best health,
Managing Editor, NHD “Health Watch”