A new study in the New England Journal of Medicine suggests angioplasty may not be superior to medication in combating heart disease, preventing heart attack, and alleviating chest pain. Understanding the results of studies like this one can be tricky for the layperson, so we've got an expert on to answer all your questions: cardiologist Dr. Steve Nissen, president of the American College of Cardiology. Do you have an angioplasty scheduled? Should you opt for medication instead? When is a stent still the best option? Dr. Nissen takes your calls, emails, and comments.
Blog Of The Nation
March 28, 2007
Today on Talk of the Nation discussing the study on angioplasty/stents versus medical therapy, the question was raised, why have doctors been offering this to patients without the information found by this study?
As an internal medicine physician, I can tell you that whenever a new procedure comes out that looks promising, it gets offered to patients in the hopes that it will benefit them as individuals.
Furthermore, once a particular procedure or test becomes well known, patients will often demand it, without knowing the risks, benefits or even approved indications for it. I have had patients come to me demanding a heart catheterization, asking for a stent or demanding an MRI, when they don't really understand what they are asking for it or what these tests can do for them (or not do). Just because you saw a 4 minute segment on the prime time news about the "latest and greatest" medical innovation, doesn't mean it is for you. Just because it worked great for your brother-in-law doesn't mean that your symptoms will be amenable to the same treatment.
I see a lot of local and national news stories about doctors that misdiagnose or fail to order a "life-saving" intervention and these get sensationalized and have become part of the public consciousness, such that patients are afraid to trust doctors. Our health system has become fractured out of necessity, and it is very likely that the doctor who treats you for an acute emergency or illness won't be the doctor who follows you in clinic. Many patients I know have had long waits in ERs or physicians that fail to really communicate with them, and this has added to a public loss of trust.
But almost every doctor I know, rigorously follows the outcomes of well done studies and tries to apply the appropriate standards of care to all of their patients while individualizing care to take into accounts the indications and risks for that particular patient.
Physicians need to communicate with their patients and work to develop mutual trust and respect. Patients need to lose the (distinctly American, I think) sense of entitlement to "cutting edge" treatments that have little long-term or large population data to support their use.
Any procedure or medical test is best used when the decision to undergo it is collaborative, advised by a physician who has listened to their patient's individual needs, hopes, fears and goals.
Apparantly a primary point of the study you were discussing was that medication and lifestyle changes were almost as effective as putting in a stent. What if there are no lifestyle changes to be made?
If have strenuously excercised for decades (I'm in my 50's), eat healthy, not overweight, and get regular check ups. Several years ago I decided to try and run a marathon. While visiting my Dr. for my annual blood test/check-up, I mentioned my goal. She referred to a cardiologist. By this time I was comfortabling running 12 miles non-stop. Various stress tests, ultrasounds, etc indicated a narrowing of a artery on the heart. My cardiologist put in a stent. Right? Wrong? I don't know. My point is that there is minimal, if any, way to improve my lifestyle.
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