Researchers recently completed a study of over 10,000 heart patients and found disturbing evidence that more than a third of patients with coronary artery disease (CAD) receive more recommendations for angioplasty and fewer recommendations for coronary artery bypass surgery (CABG) than indicated by current guidelines developed by the American College of Cardiology and the American Heart Association. The purpose of the study was to confirm whether cardiologists were following existing guidelines for use of angioplasty and CABG. The conclusion of the report is a resounding “No”.
CAD is a condition in which plaque build-up starves the heart of its blood supply. CABG, also known as “open-heart surgery,” is a procedure in which the rib cage is spread open and a section of a healthy blood vessel is attached to “bypass” the blocked section of the coronary artery and improve the blood supply to the heart. Angioplasty is a less invasive procedure used to widen narrowed or blocked arteries. A thin tube, or catheter, is threaded through a blood vessel to the affected area and a small balloon is inflated to open the blockage.
The study found that only 53 percent of patients for whom the guidelines called for CABG were actually recommended for the surgery; 34 percent of these patients were instead recommended for angioplasty. Recent studies have found CAGB surgery outcomes to be better than angioplasty outcomes for most patients.
What’s also of concern is that the tendency to recommend angioplasty was emphasized at hospitals with inhouse angioplasty capabilities. Six angioplasties can be performed in the time it takes to do one bypass procedure. So, why are doctors ordering procedures not indicated by the established guidelines? Dr. Raymond J. Gibbons of the Mayo Clinic says “the recommendations for angioplasty in patients indicated for CABG reflect a ‘grow the business’ and ‘make it up in volume’ mentality in response to declining reimbursement rates.” That’s a nice way of saying profit is driving medical decisions rather than what’s the best therapy for patients.
Dr. Gibbons says this trend among cardiologists is of greatest concern to him and reflects some doctors’ reaction to the current health care insurance reimbursement system that favors tests and procedures. He fears that if these concerns are not addressed, physicians run the risk of losing the confidence of patients and will most likely result in further governmental regulation.
Richard J. Arsenault, 2011
