I read yesterday morning that I was now a party to “The Great Coronary Angioplasty Debate.” (Note to self: don’t look at Twitter before Sunday brunch.)
This all started a week ago, when Dr. Nortin Hadler posted an op-ed piece on The Health Care Blog, titled “The End of the Era of Coronary Angioplasty.” He opined that angioplasty was unnecessary in the setting of a major heart attack (a.k.a. STEMI) and might even worsen outcomes. His title and thesis was so over-the-top (intentionally so, I’m sure) that I felt obliged to pen a response to his very anti-stent article. Continue reading
Yesterday’s edition of USA Today carried an article by Peter Eisler titled, “Six common surgeries often done unnecessarily” — and, you guessed it, angioplasty and stents were at the top of the list of “six common surgeries that carry significant risks of being done without medical necessity, according to federal data and independent studies.”
I was a bit taken aback because I was not aware of any new study, federal or independent, that concluded stents were being vastly over-used. And it turns out that there wasn’t one. Continue reading
Check out the first post of 2013 on our new blog. “The Activated Patient.” It’s titled “Singing On The Table: Be Activated in 2013 with a Non-Resolution” and it’s all about what it means to be “activated” — not just for heart patients, but for the rest of us as well.
As we’ve written in the past couple of months, this whole area of patient empowerment is becoming increasingly important as the issues of shared decision-making, patient preference and patient-centered therapy have been highlighted in recently published guidelines from all the major heart organizations.
As for what “singing on the table” means, you’ll just have to read the post….
The ACCF/AHA Clinical Practice Guideline Methodology Summit Report was just released, after more than a year of work. And at the top of the list of recommendations is the inclusion of a patient representative.
You can read all about this in our new patient blog, “The Activated Patient,” including comments from Drs. Deepak L. Bhatt and Ralph G. Brindis, who served on the Workgroups for this report. Continue reading
A new article about transradial angioplasty (the placement of a stent using the radial artery in the wrist) appeared today in the Cleveland Clinic’s Heart & Vascular Health Blog, authored by their “Beating Edge Team.” Titled, “Unclogging Blocked Arteries Via the Wrist: Angioplasty approach may offer clinical benefits for certain patients,” the article’s purpose seems to be to familiarize patients with this new alternative approach to diagnostic angiography and angioplasty, “now being offered” at the Cleveland Clinic.
Unfortunately this short article, while supposedly an “advertisement” for wrist angioplasty, continues to promulgate several widely-held myths about the radial approach. Continue reading
Partnering with informed patients is a central tenant of the newly released joint 2012 Guidelines For Diagnosis and Management of Patients with Stable Ischemic Disease, as well as SCAI’s consensus update on Ad-Hoc PCI. And new studies about angioplasty and stents are being presented regularly that call for shared decision-making: for example, the OVER study, showing that endovascular repair of abdominal aortic aneurysms with stent grafts is equivalent to open surgery, the FREEDOM study discussing the options for multivessel disease in diabetic patients, and FAME 2 for the treatment of stable heart disease with significant ischemia as measured by fractional flow reserve. Patient preference comes into play in all of these. Continue reading
Cardiologist talks to a patient “on the table” in cath lab
Something that is “on the table” is defined as an item that is “up for discussion.” And this week The Society for Cardiac Angiography and Interventions (SCAI) issued a consensus statement about the proper use of “ad hoc PCI” — and the patient was definitely on the table, up for discussion, part of the conversation.
Since we’re into definitions, ad hoc PCI is the scenario in which a diagnostic catheterization is followed in the same session by PCI (angioplasty and stents). And this is a common scenario: in New York State, for example, 80% of all angioplasties are done in the same session as the diagnostic angiogram, although the vast majority of these are emergency or primary angioplasties, where a patient in the midst of a heart attack (or close to it) is brought into the cath lab and the blockage is opened up, saving the heart muscle and possibly the patient’s life. Continue reading