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Is Angioplasty Worth The Risk?

Short answer: with surgical backup ...

From CBS News:

Though A Common Medical Procedure,
Many Are Performed At Hospitals
Unprepared If Something Goes Wrong


Angioplasty is one of the most common medical procedures in the U.S.; in 2006 more than 1.3 million were done. But recent studies have cast doubt on its benefits. Now CBS News medical correspondent Dr. Jon LaPook reports on the controversy over whether too many people are getting angioplasty at hospitals that may not be prepared if something goes wrong.

In 2006, Scott Sullivan's mother, Pearl, went to Holy Name Hospital in Teaneck, New Jersey for a heart test to see what was causing her shortness of breath. She never came home.

"I went to the nurse's station and asked, 'Where's my mom?' And you could just tell by the look on the nurse's face that my mom's not alive," Sullivan recalled. "They punctured the artery, and my mom died because of it."

"Have you figured out what happened?" asked LaPook.

"I know what happened in my heart. I don't know in doctor terms," he said. "But they botched the angiogram, the angioplasty."

Pearl Sullivan's family alleges in a lawsuit they did not know the hospital had no on-site cardiac surgical back-up to handle the rare cases, about two to three in a thousand, when something goes wrong and doctors need to operate.

"We think that they're equipped to do whatever's necessary," Sullivan said. "And apparently not."

In the case of Pearl Sullivan, Holy Name said: "We are confident the evidence will show the doctors, staff and hospital acted appropriately and that this death was unrelated to the absence of on-site cardiac surgery."

Three prominent cardiology groups - the American Heart Association, the American College of Cardiology, and the Society for Cardiovascular Angiography and Interventions - say non-emergency angioplasty should only be done with cardiac surgical support on-site.

So why is the procedure still so common in small hospitals?

"Hospitals are competing to establish services which duplicate services right next door," said Dr. Elliot Fisher of the Dartmouth Medical School. "Not to the benefit of the population, but to try to preserve their financial margins. We have a medical arms race going on in this country."

Angioplasty is big business. At about $16,000 a procedure, it's a roughly $21 billion-a-year industry.

"Cardiovascular interventional procedures are big moneymakers for hospitals and for practitioners," said Dr. Steve Nissen of the Cleveland Clinic. "It's tough to walk away from that for a lot of people."

Dr. Paul Mendelowitz at Holy Name says money is not a motivation.

"What I'm telling you is that at no time, did I ever hear, 'We've gotta get into the angioplasty business because there's money to be made here,'" he told LaPook. "That was not the driver. I think the ability to do both emergency and non-emergency angioplasty allows labs to raise their quality because their volumes are higher."

Holy Name performs elective angioplasty without surgical backup as part of a closely-supervised study in 45 hospitals testing whether it's safe.

Why would somebody elect to go to a hospital that doesn't have surgical backup, versus one that does?

"Because Holy Name is their hospital," said Dr. Mendelowitz, "and they've been coming here. And maybe their parents came here. And maybe they bring their kids here. And their doctors are here."

Many experts say too many angioplasties are already being done.

"It's markedly overused," said Dr. Fisher. "Probably 40 percent of the procedures are unnecessary."

He says if patients fully understood the risks and benefits of the procedure, fewer people would have it done, let alone at a hospital without surgical back-up.

Studies show medication can be just as effective as angioplasty in patients who are not showing signs of a heart attack.

"I can tell you this," Dr. Nissen said. "If I needed a heart catheterization, and an angioplasty, I'd have it done in a major medical center. I certainly wouldn't have it done in a small community hospital, where there was no surgeon, there was no back-up."

Scott Sullivan said his family needs answers: "Why, what, when it went wrong? What time did it go wrong? Did they, for three hours were they playing around in there, trying to fix something that they weren't equipped to do? My family needs answers."

Pearl Sullivan signed a consent form both for the procedure and to participate in the study of angioplasty without surgical backup. But her family doesn't believe she understood what it meant.

From the comment section:

As a physician, we are trained never to perform a procedure if we cannot address every possible complication of that procedure. It's a simple rule that saves lives. The "you can get hit by a car by walking across the street' argument just doesn't fly in this case. Damage to the coronary artery is a known and not infrequent complication of angioplasty, and this potential complication must be addressed prior to the procedure being performed. I agree that when hospitals perform angioplasty without surgical back up, the decision is being made with profit in mind and it needlessly puts the patient at risk.

Comments

I never knew angioplasty was so common until I read this article, and I never realized how much money it brought either.

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