Patients with clogged arteries should be given more information on treatment options before they have surgery or get a procedure to clear the vessels, to cut down on unnecessary care, three U.S. heart associations said Monday.
Those with the most complex cases should be evaluated by surgeons who do bypass operations and cardiologists who implant stents to prop open arteries in a team approach to determine which is best, the revised guidelines say. Less serious patients, whose clogged arteries are now cleared during the same procedure used to find the problem, should instead meet with the physician after the diagnosis to review how the work should be done.
The guidelines are designed to rein in cardiologists who typically are first to evaluate patients and may treat them without reviewing options such as surgery and drug therapy, the heart groups said. Use of angioplasty and stents to clear and hold open arteries has surged, in many cases displacing bypass surgery that uses blood vessels to reroute blood flow around a blockage.
“These guidelines for the first time advocate a heart team approach, which may change practice,” said Jim Blankenship, vice chair of the writing committee on the guidelines and an interventional cardiologist in Pennsylvania. “When you have the advice not only of a cardiology expert but a surgical expert, patients will get a balanced and dispassionate analysis.”
The new guidance was developed by the American College of Cardiology, the American Heart Association, and the Society for Cardiovascular Angiography and Interventions. It also includes a recommendation of an 81-milligram baby dose of aspirin daily for heart patients, eliminating the treatment range that led some to take too much and develop bleeding.
Stent Advice
Only patients who are able to take aspirin and another drug for a year to prevent blood clots from forming should be given stents, sold by Boston Scientific Corp., Abbott Laboratories, and Medtronic Inc. The authors also said AstraZeneca’s newest drug, Brilinta, is equal to Plavix from Sanofi and Bristol-Myers Squibb Co., and Efient from Eli Lilly & Co. for preventing the deadly clots.
Genetic tests to identify patients who are resistant to treatment with Plavix may be useful for those at the highest risk of developing blood clots. While the tests aren’t recommended for everyone, patients who are found to have a muted response to Plavix may consider Efient or Brilinta, the guidelines say.
The heart groups updated the recommendations for bypass surgery, which underwent their last revision in 2004, and for angioplasty and stenting, which were previously done in 2005, with updates every other year.
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