Are patients getting the right cardiac care in the US?

Between 20-60% of patients with stable coronary disease may be getting unnecessary coronary stent procedures: The latest issue of JAMA the use of more than 500,000 PCIs in over 1,000 U.S. hospitals between July 2009 and September 2010. Of these, almost 150,000 patients were classified as non-acute; 71% were classified as acute and 29% as non-acute and “appropriate criteria” were applied to each. The analysis focused mainly on the non-acute group, as little controversy existed for those patients needing an acute intervention.

In this non-acute group, only 50% were classified as "appropriate"

We have commented on similar reports repeatedly ever since results of  The COURAGE trial was questioned in an article published in The Wall Street Journal in February, 2010. At a cost of $20,000, PCI for stable CAD does not prolong life, protect against progression of disease or future heart attacks, unlike coronary artery bypass surgery. Society costs for this may be as $15B per year as opposed to medical therapy that has become just as effective in these patients as PCI - at a fraction of the cost.

However, since COURAGE was first published in 2007, few if any changes have occurred in the use of PCI. It is therefore unlikely, that there will be a lasting positive effect on PCI practices with this publication. Likewise, I suspect the negative effect of this news on the medical device industry will only cause a very temporary ripple effect.

Tell me what you think,

Dr T


1): Appropriateness of Percutaneous Coronary Intervention, Chan, P. S. et al. JAMA 2011; 306:53-61


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