Monday, August 19, 2013

George W. Bush's heart surgery prompts debate about stents

Americans have become familiar with the idea of using stents to open blocked arteries, so when former President George W. Bush underwent stent surgery recently, most people probably viewed the decision as routine.

But there is -- and should be -- a national debate about when to use this expensive therapy.

Here's an excerpt from the blog Health Beat by Maggie Mahar, who quoted Bloomberg News: 

“The discussions have been ongoing since 2007, when the trial known as Courage first found that less costly drug therapy averted heart attacks, hospitalizations and deaths just as well as stents in patients with chest pain. The results were confirmed two years later in a second large trial.

“The debate has centered on both the cost of stenting, which can run as high as $50,000 at some hospitals, and its side effects, which can include excess bleeding, blood clots and, rarely, death. Opponents say the overuse of procedures like stenting for unproven benefit has helped keep U.S. medical care on pace to surpass $3.1 trillion next year, according to the U.S. Centers for Medicare and Medicaid Services.

“ 'This is really American medicine at its worst,' said Steven Nissen, head of cardiology at the Cleveland Clinic in Ohio  . . .  ‘It’s one of the reasons we spend so much on health care and we don’t get a lot for it. In this circumstance, the stent doesn’t prolong life, it doesn’t prevent heart attacks and it’s hard to make a patient who has no symptoms feel better’ . . .

“ 'Stents are lifesaving when patients are in the midst of a heart attack,’ added Chet Rihal, an interventional cardiologist at the Mayo Clinic in Rochester, Minnesota. ‘...They allow immediate and sustained blood flow that help a patient recover. For those who aren’t suffering a heart attack, the benefits are less clear   . . . While stents may be used in patients with clear chest pain, there’s no evidence that they prevent future heart attacks.’  A review of eight studies published last year in JAMA (Journal of the American Medical Association) Internal Medicine also found no differences."