Note: This post first appeared at Goozner’s blog, Gooznews.
A new important and depressing study appeared last week in the Journal of the American Medical Association. Researchers who poured over Medicare records found that
less than half of seniors (44.5 percent) with stable coronary artery
disease who complained of symptoms like angina were whisked off to the
catherization lab for percutaneous coronary interventions (PCI) like
balloon angioplasty and stenting without first confirming by a stress
test that they were indeed suffering from reduced blood flow to the
heart (ischemia). Guidelines published by American College of
Cardiology, the American Heart Association and, significantly, the
Society for Cardiology Angiography and Intervention call for the tests.
Previous studies among the commercially-insured population are even
worse. Only a third of patients in the under-65 crowd with stable heart
disease but having symptoms are likely to have gotten a stress test
before getting PCI.
Why is this important? Let us count the ways:
* PCIs have increased 300 percent over the past decade and
accounted for at least 10 percent of the increase in Medicare spending
since the mid-1990s.* Medicare spends $10,000 to $15,000 per PCI.
* While PCI may reduce ischemia and angina more effectively than
drugs, more than a half dozen studies conducted over the past decade
have established that in terms of reducing deaths or heart attacks, PCI
is no better than drugs alone.* Patients who fail a stress test and then get PCI do better and have shorter hospital stays; and
* Patients who get PCI with minimal symptoms, with or without the
stress test, are at increased risk of repeat procedures and may
experience a deterioration in their overall quality of life going
forward.
