U.S. Docs Overuse Heart Stents
U.S. heart patients are more likely to undergo stenting procedures to clear blocked coronary arteries than Canadians are, new research shows, but this doesn't necessarily mean they're getting better care.
Such procedures, in which blocked heart arteries are cleared and then propped open with stents, are life-saving for heart attack patients. But a 2007 study showed that for patients with "stable" disease — meaning they aren't experiencing chest pain at rest — drugs are just as effective.
The procedures are "highly profitable and generate considerable revenue for hospitals" under the United State's current health care payment system, Dr. Edward L. Hannan of the State University of New York at Albany and his colleagues note in the new study, published in the journal Circulation.
Under Canada's health care system, the researchers add, provincial governments control the volume of heart surgeries, as well as funding for these procedures. A stent procedure typically runs into the thousands of dollars, more if newer devices are used.
Hannan and his colleagues had previously reported that rates of stenting procedures and bypass surgery were about twice as high in New York state compared to Ontario in the early 1990s. In the current study, they looked at data covering 1997 to 2006.
In 2004-2006, the researchers found, after adjusting for various factors, the rate of elective stenting was 2.3 times as high in New York as it was in Ontario, while rates of bypass surgery for these patients were about the same. About one in 280 people in New York had a stent, compared to about one in 550 in Ontario.
For acute patients, meaning they needed to undergo a procedure as soon as possible, stent rates were 30 percent higher in New York, while bypass surgery rates were 40 percent higher.
But when the researchers looked at patients undergoing emergency stenting, they found rates were twice as high in New York as they were in Ontario.
"This certainly suggests that there may be overuse of angioplasty (expanding the artery with a balloon and then inserting a stent) for elective patients in New York and maybe not quite enough use of it for emergency heart attack patients in Canada," Hannan told Reuters Health.
For example, in both the United States and Canada, there was some evidence that cardiologists were paying attention to evidence that for heart attacks, stenting was better than bypass operations, Dr. Thomas Ryan, of Boston University, noted in an editorial accompanying the study.
While the study didn't look at outcomes for patients, Hannan said, this type of research is a major focus of healthcare reform efforts; the idea, he explained, "is to try to figure out what treatment is best for whom in the real world, and if one treatment is ideally better."
The study "highlights the challenges involved in terms of potential policy options for trying to control the rising costs of healthcare while trying to optimize patient outcomes in both countries," the authors conclude.
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