To measure the research’s impact, the new study evaluated data on nearly half a million US patients with artery blockages but stable disease treated between 2005 and mid-2009. Two-thirds had chest pain and all eventually got artery-opening stents during an angioplasty.
Before the landmark findings, fewer than half the patients received drug treatment first, then an angioplasty. In the two years after the study, there was only a tiny increase in patients given drug treatment first — to about 45 percent.
The earlier research suggests many of those given drugs first wouldn’t need an eventual angioplasty, said Dr. William B. Borden, author of the new study and a cardiologist at New York-Presbyterian Hospital/Weill Cornell Medical Center.
He said the 2007 results also show all patients should get drug treatment after an angioplasty to help prevent heart attacks. In his follow-up study, that number increased slightly, but still, almost one-third were not given recommended medication after their angioplasties.
Dr. William Boden of Buffalo General Hospital, who led the 2007 study, said the new results aren’t surprising because it takes time for doctors to change practice. The landmark study’s recommendations will be included in new treatment guidelines due out this year, said American Heart Association spokesman Dr. Sidney Smith. He said that should influence more doctors to use the drug approach first.
The new study appears in yesterday’s Journal of the American Medical Association.
The drugs it evaluated — aspirin, beta blockers, and statins — improve artery health and reduce chest pain. They’re available as generics and cost much less than angioplasties.
Angioplasties do the same thing. Doctors guide a narrow tube through a blood vessel near the groin up toward the heart, inflate a tiny balloon to flatten blockages, and insert a stent to keep arteries propped open. The procedure costs about $20,000, based on average Medicare reimbursement for doctor and hospital fees, and generally requires an overnight hospital stay, said Dr. Sanjay Kaul, a Los Angeles cardiologist.
Kaul estimates that of the $10 billion spent nationwide on these procedures each year in stable patients, more than $2 billion could be saved if drug treatment were tried first, and angioplasties performed only if that didn’t work.
The $33.5 million landmark study challenged conventional thinking on the value of heart stents. Boden said there are many reasons why doctors and patients may resist the drug approach. “People feel it’s too time-consuming, it’s too labor-intensive,’’ Boden said. “Patients say, ‘I don’t like to take meds, let me have a stent.’ ’’
Kaul said doctors may fear being sued if they don’t perform angioplasties and patients on drug treatment have heart attacks or die.
