The business of healing hearts

Cardiac care is a money-making machine that too often favors profit over science

Last reviewed: September 2011
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As baby boomers hit their 60s and heart disease remains the No. 1 killer of all U.S. adults, it's no surprise that ads exploiting people's concerns about their heart are cropping up everywhere.

"Find a new way to tell Dad you love him," suggests an ad from the Heart Hospital of Austin, in Texas. "Show your love with a HeartSaver CT."

The website Track Your Plaque warns, "The old tests for heart disease were wrong—dead wrong." It says heart scans are "the most important health test you can get."

"Does your annual physical use the latest technology to prevent … heart disease before it strikes?" asks the radio ad for the Princeton Longevity Center, in Princeton, N.J. The center's website promises that its full-day exams—which can include heart scans and usually aren't fully covered by insurance—can detect the "silent killers that are often missed in a typical physical exam or routine blood tests."

Those and similar ads are not unusual. They are part of a marketing strategy by hospitals, medical centers, and doctor groups to cash in on consumers' fears.

"It's a big problem," says Kimberly Lovett, M.D., a physician at Kaiser Permanente and a member of the San Diego Center for Patient Safety at the University of California, San Diego School of Medicine. "These marketing strategies exploit patient fears and promote tests that aren't necessary for most people."

In a June 2011 editorial in the Journal of the American Medical Association, Lovett suggests that inappropriate testing can lead to inappropriate treatment. "Direct-to-consumer cardiac testing may pose more harm than benefit," she writes.

Lovett is one of a growing chorus of physicians calling for a crackdown on indiscriminate testing and treatment in favor of an evidence-based approach to cardiac care.

But money talks—often loudly enough to drown out those voices. As doctors and hospitals add more and more expensive high-tech gadgetry to their arsenals, all too often it's profit, not science, driving decisions on how heart disease is detected and treated in the U.S.

A Consumer Reports investigation—including interviews with doctors and other health professionals, our own survey of more than 8,000 subscribers, and analysis of medical research, marketing materials, and the available data on heart doctors—shows the following:

Steven Nissen, M.D.
Financial incentive
Steven Nissen, M.D., says health care favors more costly procedures.
Photograph by Keith Berr
  • People often get the wrong tests. Good tests detect disease and lead to effective treatments. But many heavily marketed cardiac tests don't do that. "I can understand how people would think ‘what's the harm?'" Lovett says. "But not only is the wrong test a waste of resources, it can be downright dangerous if it leads to inappropriate treatment."
  • Angioplasty is overused. Recent research suggests that many patients in nonemergency situations are rushed to angioplasty, an invasive procedure to clear blockages in the coronary arteries, when dietary changes and exercise, plus drugs, would be just as effective and much safer. Other research shows that angioplasty is also too often used for severe blockages, when surgery to bypass the occluded arteries could provide longer-lasting benefits.
  • Consumers don't have enough information on heart doctors. To help fill that gap, we've teamed with the Society of Thoracic Surgeons to publish ratings of heart-surgery groups that perform bypass surgery. Unfortunately, there's no comparable registry for interventional cardiologists, who perform angioplasty. So if you want information about those doctors, you'll have to ask some tough questions.
  • Real differences exist among heart surgeons. When there is solid information on doctors, such as with heart-surgery groups, the data show that quality can vary in important ways. In addition, recent research reveals that many practices aren't following the latest guidelines. It pays to thoroughly explore your options.
  • Heart disease is often misunderstood. Many patients, and even some doctors, have an outdated understanding of the best way to prevent heart attacks.

"Medicine doesn't change quickly or easily," says Steven Nissen, M.D., chairman of the department of cardiovascular medicine at the Cleveland Clinic in Cleveland, Ohio. "It may take years for evidence to trickle down to private practice."

Another reason for consumers to be alert, Nissen adds, is the health-care system favors expensive procedures. "Physicians are reimbursed far more for a 20-minute angioplasty than an hour-long discussion," he says. "Those financial incentives inevitably drive clinical decisions. That's why patients have to do their own due diligence to get the best care."