Sometimes, heart disease erupts as a full-blown emergency with sudden, crushing chest pain. That’s when immediate intervention to restore blood flow to the heart can be lifesaving.

But in many situations, the path to aggressive care moves faster than called for, which can lead to overtreatment as well as worse outcomes and complications, says William Boden, M.D., a professor of medicine at the Boston University School of Medicine. When it comes to treating heart disease, Boden says, “there are many clinical instances when less is more.”

Boden and other experts suggest that when it’s not an emergency, you slow down and do more research so that you can make smart decisions. That involves talking with your doctors about everything from whether you really need an expensive imaging test or invasive procedure to which hospital to choose if you do need open heart surgery.

And if you feel rushed into making a decision, “ask for a second opinion,” Boden says.

Here are the key questions to ask along the way:



Do I Really Need That Test?

The heart disease treatment odyssey often starts on a treadmill in a doctor’s office, as part of an exercise stress test. That test can be essential if you have symptoms that indicate heart disease, such as chest pain while exercising, or if you’re at high risk of a heart attack.

But some doctors include exercise stress tests as part of routine checkups, or as a safety check in people heading to certain surgeries.

Experts we spoke with said that’s generally not a good idea, in part because for people without symptoms of heart disease the test is often more likely to reveal a harmless abnormality than identify a real problem.

So if you feel fine and are at low risk, before you agree to a stress test ask why it’s necessary, says Marvin M. Lipman, M.D., Consumer Reports’ chief medical adviser. “If you don’t get a satisfactory answer, politely decline it or ask for a second opinion,” he says.

Are Drugs or Stents Better?

If you do undergo a stress test and it has abnormal or uncertain results, your doctor will probably refer you to a “cath lab,” or catheterization laboratory, for more tests. And that’s where the cascade of procedures often speeds up.

In that lab, a physician first performs coronary angiography, which involves threading a thin tube into an artery and injecting a dye so that narrowing shows up on an X-ray.

But patients are sometimes asked to sign a consent form that allows doctors, if they see restricted blood flow, to immediately perform a procedure called angioplasty to remove the blockage.

That’s not usually necessary, Boden says. “What should happen is hitting the pause button and having a thoughtful, transparent discussion of all the treatment options,” he says.

Performing an angioplasty involves a doctor inflating a thin balloon in the artery to widen it at the blockage, leaving a stent in place to prop the blood vessel open. It can be lifesaving when performed within hours of a heart attack.

But in other circumstances, lifestyle changes plus drugs to control blood pressure and cholesterol levels and prevent clots is at least as effective and usually safer. A 2016 review in JAMA Internal Medicine found that approach could cut the number of angioplasties by 80 percent.

One explanation for the continued overuse of angioplasty is that it is seen as a moneymaker for doctors and hospitals, says David Brown, M.D., a cardiologist at the Washington University School of Medicine in St. Louis.

Obviously, that’s not a good enough reason to have it. Instead, if you’re scheduled for angiography, talk with your doctor about what to do if that test finds worrisome—but not immediately dangerous—signs of harm.

It often makes sense to try two to three months of lifestyle changes and drugs first, and turn to angioplasty and stents only if those measures don’t ease your symptoms enough.

Hospital Ratings: Find Top Hospitals for Heart Surgery
Click on the icons in the map below to see how well hospitals in your area rate for bypass, valve replacement, and pediatric heart surgery.
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WORSE THAN EXPECTED AS EXPECTED BETTER THAN EXPECTED

Which Hospital to Choose?

In some cases, heart disease is so serious that drugs, even when combined with angioplasty, may not be enough. In that case you probably need open heart surgery, often to either bypass blood flow around blockages in your coronary arteries or to correct a malfunctioning heart valve.

Though both problems are serious, they’re not always emergencies, says Steven Nissen, M.D., chairman of the department of cardiovascular medicine at the Cleveland Clinic Foundation. Patients should be wary of doctors who do an angiogram in a nonemergency “and then say, ‘We can do your bypass tomorrow,’ ” Nissen cautions.

Instead, your doctor can often stabilize your condition with drugs, giving you time to consider options. Though that’s not something many people think of doing, Nissen says they should. “People will often do a better job comparison shopping with a car they might buy than the heart program they go to.”

Unfortunately, finding that information is harder than it is for cars. But Consumer Reports now has updated ratings of almost 500 hospitals nationwide on how they perform on open heart surgery, including coronary bypass surgery and aortic valve replacement.

The ratings are published in partnership with the Society of Thoracic Surgeons (STS), which collects data directly from hospitals on several key measures, including actual mortality and complication rates.

Most other hospital ratings rely instead on billing records that hospitals submit to insurers, which tend to be less accurate, says David Shahian, M.D., a professor at Harvard Medical School who also oversees the STS data registry, quality measurement, and public reporting efforts.

In addition, STS holds hospitals to high standards, Shahian says. “So even those whose STS score is ‘as expected,’ or average, typically provide high-quality care, and those that earn our highest rating are truly outstanding.”

Hospitals share their data voluntarily. “Low-scoring hospitals deserve credit for having the courage to report,” he says. “They’re demonstrating their commitment to transparency and improvement.”

Which hospital you choose matters. Of the hospitals in our ratings, only about 70 appear in our chart of best heart hospitals that appear at the end of this report. (Note that Cleveland Clinic does not appear in the chart; though it earns a top score for valve replacement, it could not be rated on bypass surgery due to incomplete data.)

Choosing the right surgeon is also important. Though information about specific surgeons is even trickier to find, Consumer Reports, working with STS, does report outcomes on heart surgery for groups of surgeons who practice together. Those ratings are available at CR.org/heartsurgeons.

If the surgical group you’re considering is not listed, ask the surgeon about how well it performs on the STS measures. If the surgeon can’t share that information—or won’t—we suggest you keep looking.

If you're reading this article on your smartphone, we recommend you rotate your phone to landscape mode to better view the tables below.


Ratings for Hospitals in the Northeast


Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont
Hospital
Location
Coronary Artery Bypass Surgery Aortic Valve Replacement Surgery
Cape Cod Hospital
Hyannis, MA
Jeanes Hospital *
Philadelphia, PA
Steward St. Elizabeth's Medical Center
Brighton, MA
The Valley Hospital
Ridgewood, NJ
UMass Memorial Medical Center
Worcester, MA
Vassar Brothers Medical Center
Poughkeepsie, NY
Baystate Medical Center
Springfield, MA
Catholic Medical Center
Manchester, NH
Forbes Hospital
Monroeville, PA
Heritage Valley Beaver
Beaver, PA
Jersey Shore University Medical Center
Neptune, NJ
Massachusetts General Hospital
Boston, MA
Mount Auburn Hospital
Cambridge, MA
Penn State M.S. Hershey Medical Center
Hershey, PA
Robert Wood Johnson University Hospital
New Brunswick, NJ
St. Joseph's Hospital Health Center
Syracuse, NY
St. Luke's University Hospital
Bethlehem, PA
The Mount Sinai Hospital
New York, NY
UPMC Hamot
Erie, PA
Yale New Haven Hospital
New Haven, CT
York Hospital
York, PA
Footnote
* This hospital reports its data to ​the Society of Thoracic Surgeons but not to Consumer Reports. We have included the hospital's ratings ​here​ with its permission.

For more on our hospital ratings, go to CR.org/howweratehospitals


Ratings for Hospitals in the South


Alabama, Arkansas, Delaware, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia, Washington, D.C.
Hospital
Location
Coronary Artery Bypass Surgery Aortic Valve Replacement Surgery
Cone Health - Moses Cone Memorial Hospital
Greensboro, NC
Emory Saint Joseph's Hospital
Atlanta, GA
Lynchburg General Hospital
Lynchburg, VA
Memorial Regional Hospital
Hollywood, FL
Orlando Health
Orlando, FL
Sarasota Memorial Health Care System
Sarasota, FL
The Heart Hospital of Baylor Plano
Plano, TX
Vidant Medical Center
Greenville, NC
Duke Regional Hospital
Durham, NC
Harlingen Medical Center
Harlingen, TX
Holston Valley Medical Center
Kingsport, TN
King's Daughters' Medical Center
Ashland, KY
McLeod Regional Medical Center
Florence, SC
MedStar Heart Institute MedStar Washington Hospital Center
Washington, DC
Morton Plant Hospital
Clearwater, FL
Naples Community Hospital
Naples, FL
Providence Hospital
Columbia, SC
Saint Thomas Midtown Hospital
Nashville, TN
Saint Thomas West Hospital
Nashville, TN
The Medical Center at Bowling Green
Bowling Green, KY
TriStar Centennial Medical Center
Nashville, TN
University of Tennessee Medical Center
Knoxville, TN
University of Virginia Health System
Charlottesville, VA
Vanderbilt University Medical Center
Nashville, TN
WellStar Kennestone Regional Medical Center
Marietta, GA
Winchester Medical Center
Winchester, VA

For more on our hospital ratings, go to CR.org/howweratehospitals


Ratings for Hospitals in the Midwest


Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, Wisconsin
Hospital
Location
Coronary Artery Bypass Surgery Aortic Valve Replacement Surgery
Boone Hospital Center
Columbia, MO
St. Cloud Hospital
Saint Cloud, MN
Advocate Lutheran General Hospital
Park Ridge, IL
Borgess Medical Center
Kalamazoo, MI
Edward Hospital *
Naperville, IL
Henry Ford Macomb Hospital
Clinton Township, MI
Hillcrest Hospital
Cleveland, OH
Kansas Medical Center
Andover, KS
Nebraska Methodist Hospital
Omaha, NE
OSF Saint Anthony Medical Center
Rockford, IL
St. John Providence System - St. John Hospital and Medical Center
Detroit, MI
University Hospitals Case Medical Center
Cleveland, OH
University of Wisconsin Hospital and Clinics
Madison, WI
Footnote
* This hospital reports its data to ​the Society of Thoracic Surgeons but not to Consumer Reports. We have included the hospital's ratings ​here​ with its permission.

For more on our hospital ratings, go to CR.org/howweratehospitals


Ratings for Hospitals in the West


Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming
Hospital
Location
Coronary Artery Bypass Surgery Aortic Valve Replacement Surgery
Kaiser Sunnyside Medical Center
Clackamas, OR
Dixie Regional Medical Center
Saint George, UT
El Camino Hospital
Mountain View, CA
Kaiser Foundation Hospital - Los Angeles Medical Center
Los Angeles, CA
Portneuf Medical Center
Pocatello, ID
Providence Sacred Heart Medical Center and Children's Hospital
Spokane, WA
Ronald Reagan UCLA Medical Center
Los Angeles, CA
Saint Joseph Hospital
Denver, CO
Sequoia Hospital
Redwood City, CA
St. Joseph Medical Center
Tacoma, WA
Stanford Health Care
Palo Alto, CA
Virginia Mason Medical Center
Seattle, WA

HOW WE RATE HOSPITALS: The data come from the Society of Thoracic Surgeons for hospitals that have agreed to share their information with us. Bypass surgery ratings: This reflects a hospital's performance in isolated coronary artery bypass graft surgery between July 2015 and June 2016. The rating is a composite of four measures: survival (percentage of patients who leave the hospital and survive at least 30 days after surgery), complications (percentage of patients who avoid the most serious complications, including needing a second operation, developing a deep chest infection, suffering a stroke or kidney failure, and requiring prolonged ventilation), best surgical technique (percentage of patients who receive at least one graft from an internal mammary artery, located under the breastbone, which improves survival), and right drugs (percentage of patients who receive beta-blockers before and after surgery to control blood pressure and heart rhythm, aspirin or similar drugs to prevent blood clots, and a drug to lower cholesterol). Aortic valve replacement ratings: This reflects a hospital's performance in surgical aortic valve replacement between July 2013 and June 2016. It does not include data for a newer procedure, transcatheter aortic valve replacement. The valve replacement rating is a composite of two measures: survival (percentage of patients who leave the hospital and survive at least 30 days after surgery) and complications (percentage of patients who avoid the most serious complications, which are the same as for bypass). For more on our hospital ratings, go to CR.org/howweratehospitals

Editor's Note: This article also appeared in the May 2017 issue of Consumer Reports magazine.