The Consumer Reports Health Ratings Center unveiled its first doctor ratings based on a new collaboration with The Society of Thoracic Surgeons (STS), publishing a list of 50 top-rated heart-bypass surgical groups in the United States. The surgeon ratings plus advice about treating heart disease are available in the October issue of Consumer Reports and online at ConsumerReportsHealth .org.
Consumer Reports Health collaborated with STS to publish its ratings of 221 surgical groups in the United States that perform standard heart bypass operations known as coronary artery bypass grafting (CABG). The ratings are based on 11 standardized measures that fall into four categories. Two of them — recommended medications and optimal surgical technique — reflect how well surgeons adhere to the best-established practices. The other two — patient survival and the absence of surgical complications — reflect how their patients fare.
What to watch for
Would you recognize a heart attack? Do you know what tests are needed to diagnose heart disease? Cardiovascular disease remains the No. 1 killer of men and women in the United States, in part because heart attack victims often don’t recognize the symptoms and delay getting care.
According to Consumer Reports, chest discomfort is the most common symptom, but women are somewhat more likely than men to experience others, such as nausea, shortness of breath, and pain in the back or jaw. Women are also prone to an especially deadly reaction: denial.
So how do you know which symptoms warrant concern? If an area is tender when you push on it or hurts more when you breathe deeply, you’re probably not having a heart attack. But if exertion triggers or worsens the discomfort, it might be heart-related chest pain. Symptoms such as cold sweats and difficulty breathing are red flags but can indicate other health problems.
Common symptoms of heart attack are chest discomfort (pain, pressure, squeezing or fullness in the chest); upper-body symptoms (pain or discomfort in one or both arms, the back, jaw, neck or stomach); and general symptoms: cold sweats, light-headedness, nausea or shortness of breath.
If you suspect you’re having a heart attack, call 911 immediately. Then chew and swallow one 325-milligram uncoated aspirin (or four 81-milligram baby aspirins) to help prevent clots from forming in your coronary arteries. Don’t even think about driving to the hospital yourself or having someone take you.
If you’re with someone who might be having a heart attack, ask whether an automatic electronic defibrillator (AED) is available, in case the person becomes unconscious and doesn’t have a pulse. Those easy-to-use devices check heart rhythms and deliver a shock if needed.
Getting the right tests
Consumer Reports Health evaluates the following tests:
CT coronary angiography, a noninvasive test that provides a three-dimensional image of the heart, is widely touted in direct-to-consumer ads. But it carries a hefty radiation dose and can register false positive results that can lead to additional invasive tests and procedures.
Stress tests measure the heart’s function while it’s stressed by exercise or possibly medication. Some doctors use it for people with no heart symptoms as part of a routine exam. That’s generally not advisable because the test is not as accurate in low-risk people and can lead to further follow up testing that can be unnecessary and expensive. For people with symptoms of heart disease, though, a stress test should usually be the first test ordered.
Coronary angiography is the gold standard for confirming heart disease in people with worrisome stress test results, but going straight to such an invasive test is warranted only for people at a very high risk of heart disease or have symptoms or an underlying condition that could make stress testing risky.
CT angiography and electron beam computed tomography have almost no role in treating people without symptoms of heart disease and are of limited use even for those who do have them.