Heart bypass surgery on the decline

You might think that a drop in heart bypass surgeries would be good news. But some patients who would have undergone bypass surgery a decade ago are now instead having other procedures, such as angioplasty, that might not be as effective for them, according to a study published this week in the Journal of the American Medical Association.

Heart bypass surgery (in which heart surgeons use grafts to reroute blood around blocked coronary arteries) and angioplasty (where doctors use balloons to push the blockages aside and then place stents to prop open the arteries) are among the most common and costly procedures performed in U.S. hospitals. Over a million occur each year, and Medicare pays more than $6.5 billion for them.

The new study tracked the rate of the procedures at U.S. hospitals between 2001 and 2008, and found a steady drop in bypass surgery over that time, while angioplasty and other alternative procedures remained about the same.

Guidelines for who is a candidate for the procedures have changed little over that span, say the researchers, but the evidence suggests that some patients are getting angioplasty today who are actually candidates for heart bypass surgery. Moreover, the declining number of bypass surgeries has some experts worried that fewer heart surgeons will have the experience necessary to perform the complicated procedures. For example, the study found that ten years ago only 10 percent of hospitals performed fewer than 100 bypass surgeries a year. By 2008, that number grew to 25 percent.

Bottom line. While heart disease is a serious problem, in most cases you don't have to rush into a decision whether to have angioplasty or bypass surgery. Instead, take your time to discuss your options with your doctors, including lifestyle changes and medication, which in some cases is all you really need. For details, see our advice on treating heart disease. If bypass surgery is necessary, use our heart surgery ratings to find a good surgical group.

Source
Coronary Revascularization Trends in the United States, 2001-2008 [Journal of the American Medical Assocation]

—Kevin McCarthy