Archive for Friday, March 30, 2007

Patients, doctors question heart care after release of study

March 30, 2007


— Heart patients around the country are calling their doctors to question plans to treat clogged arteries with stents. It is the early fallout from a big study that showed drugs work just as well in nonemergency cases to prevent heart attacks, deaths and, over the long run, chest pain.

But Americans love a quick fix, and some doctors make a lot of money providing it. Many experts predict the study will not drastically cut the number of angioplasties that are done unless insurers balk at the $40,000 cost and force patients to try drugs first.

"People want their chest pain to go away right away. They don't care about three years, they want it gone tomorrow," said Dr. Christopher Kramer, a University of Virginia heart specialist.

At issue is angioplasty, in which a tiny balloon is snaked through an artery and inflated to flatten a blockage. Mesh tubes called stents are usually placed to keep the vessel open. It is the gold standard for treating heart attacks and worsening symptoms that land people in the hospital. Doctors say no one who has chest pains should delay seeing a doctor.

But in recent years, angioplasty also has become popular for treating patients with chest pain who aren't in imminent danger - despite the fact that no big studies ever proved it better than medications alone.

This week at a cardiology conference in New Orleans, doctors presented results of the first big study to test this. It found that drugs were just as good for preventing heart attacks and death in these elective cases. Angioplasty was better for chest pain early on, but that waned over time.

At the start of the study, 80 percent had chest pain. Three years into it, 72 percent of the angioplasty group was free of it as was 67 percent of the drug group. By five years, there was no difference.

Critics immediately attacked. A doctor who consults for stent makers called the study "rigged to fail." Others shifted their rationale to quick symptom relief rather than preventing heart attacks.

Some quibbled over how widely the results apply. Others said patients will not give drugs a chance. A stent maker said results would have been better if more people had received newer drug-coated stents.

Word spread through the meeting that from Texas to New York, patients were calling to cancel or question procedures.

Tom Elghanayan, a 61-year-old real estate developer, read about the study on Tuesday as he waited for a heart test and became alarmed. A week earlier, his doctor had referred him to a specialist, warning that he might need angioplasty on the spot. The test showed the clog to be less severe, so he left with prescriptions for aspirin and cholesterol-lowering statin drugs.

Had it been worse, "A week ago, I might have offered a stent," said the specialist, Dr. Kirk Garratt of Lenox Hill Hospital in New York.

So many people are unwilling to accept results that go against their beliefs and business interests that the study seems destined to have less impact than many believe it should.

"There are huge vested interests that are going to push back on these results, and they have already begun to do so," Dr. Salim Yusuf of McMaster University in Hamilton, Ontario, said at the meeting.


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