Are heart patients having unnecessary surgery?

Less than half of people having angioplasty surgery for heart disease were taking the best combination of drugs before their procedure, new research shows. This could mean their surgery was not needed.

Coronary angioplasty (also known as percutaneous coronary intervention, or PCI) is life-saving in the right situation—for example, if you've just had a heart attack. But for the many folks with stable heart disease, its benefits are less certain.

Research has proven that taking the right combination of medications—aspirin or a similar drug, a statin to lower cholesterol and a beta-blocker to lower blood pressure—works just as well to prevent heart attacks and prolong life, compared with angioplasty. Angioplasty may have the edge on control of symptoms, such as angina pain, but guidelines say that people should try medication first.

So are these guidelines being followed? Not according to a survey of a big angioplasty registry, which looked at data about almost 500,000 patients. Just 44 in 100 people were being treated with the recommended combination of drugs (or had documented reasons why they couldn't take them) at the time of surgery.

The publication of the definitive study showing that angioplasty was no better than medication didn't make any difference to the figures. And, even more worrisome, those patients who had angioplasty didn't always get the best medication before being sent home. (It's important to take medication after an angioplasty, to give it the best chance of working.)

So not only were doctors missing an opportunity to see whether their patients really needed angioplasty, but they were also missing another chance to be sure they benefited from the surgery afterward.

Bottom line. If you are considering angioplasty, be sure you understand what the risks and benefits of the operation are for you. Remember, if you have stable heart disease, angioplasty is no more likely to help you avoid a heart attack than taking the best medication. If your doctor recommends angioplasty, ask him or her to explain why this is better for you than taking medication.

Source
Patterns and intensity of medical therapy in patients undergoing percutaneous coronary intervention [Journal of the American Medical Association]

—Anna Sayburn, BMJ Group

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