Healthcare - Stents

[LesPalenik]

Interesting, but not surprising findings about artery clearing, stenting and bypass surgeries have been reported by researchers on heart disease treatments.

Many patients with severe but stable heart disease who routinely undergo invasive procedures to clear and prop open clogged arteries would do as well by just taking medications and making lifestyle changes, U.S. researchers reported on Saturday.

Just eliminating unnecessary stenting procedures could save the U.S. healthcare system $570 million annually, said Stanford University School of Medicine cardiologist and study co-chair Dr. David Maron. He estimates the cost per stenting procedure at about $25,000 and bypass surgery at $45,000.

The main goal of the trial was an overall reduction in deaths, heart attacks, hospitalization for unstable chest pain or heart failure and resuscitation after cardiac arrest. On these measures, the addition of stenting or bypass surgery to reroute blood flow around the arterial blockage was no better at reducing the adverse events than medical therapy alone. The invasive treatments did result in better symptom relief and quality of life in those who had frequent chest pain.

The findings do not apply to all heart patients, including those with blockages in the left main coronary artery, Hochman said. And, she added, “if you’re having a heart attack, stents save lives.”

https://www.reuters.com/article/us-health-heart-stent-idUSKBN1XQ0MR

[JoeKitchen]

There was a really good documentary on this on Netflix a little while back.  They were comparing two technologies that came around at the same time, stenting and a device that could be used to measure levels of a (I forgot exactly what) substances that correlates to clogged arteries. 

The conspiracy theory was that since stents generate a lot of money, everything else was ignored. 

[LesPalenik]

Money plays a significant role in stent procedures. Heart stents are used twice as often in U.S. vs. Canada. Over 1.8 Million stents are implanted per year in the U.S.

https://idataresearch.com/over-1-8-million-stents-implanted-per-year-in-the-u-s/

[petermfiore]

Money plays a significant role in stent procedures. Heart stents are used twice as often in U.S. vs. Canada. Over 1.8 Million stents are implanted per year in the U.S.

Of course more are done in the US...after all it is the instant fix.

Peter

[KLaban]

Personally I thank heart stenting and carotid endarterectomy for saving my life.

[Alan Klein]

Of course more are done in the US...after all it is the instant fix.

Peter

I read the article yesterday.  I had triple bypass last April when the doctors forgoed installation of stents during a catherization check after I failed a cardiac stress test.   They found my arteries so clogged stents would not work, so they said. I was already on blood pressure reducing medicine, aspirin, lipid stuff and diabetes medicine.  I had been complaining of chest pain.  So my cardiologist would not even let me go home. He had me admitted right then. I had the bypass surgery 6 days later after the blood thinning aspirin had clear out of my system.  Fortunately I never had a heart attack so my heart appears still very strong and I'm feeling better than I have for years.  Also lost weight, my lipids are great and my diabetes check looks pretty good.

Would I have done anything different if I read this first?  I doubt it.  When your cardiologist tells you might have a heart attack any minute and won;t even let you go home to wait the week for the operation and take the chance, it's hard to argue about what to do.  You kind of go along with it.

I still have to change the way I live because "new" arteries can clog in the future and diabetes is just a very bad damaging disease for everything in a body.  In any case, I can't reverse the bypass.  I just have to be thankful I'm alive and seem to be doing well currently .  Now it's up to me going forward.  And God.   

[Alan Klein]

Personally I thank heart stenting and carotid endarterectomy for saving my life.

Glad you're doing well. 

[Slobodan Blagojevic]

Money plays a significant role in stent procedures. Heart stents are used twice as often in U.S. vs. Canada...

That’s because we don’t have to worry if the death squads will approve the procedure, based on budgetary constraints.

[KLaban]

Glad you're doing well.

Thanks, and right back at you!

I had the heart stent after a heart attack and the carotid endarterectomy after a series of transient ischemic attacks.

I'm not a medical man, but think the article is probably more relevant to those who are asymptomatic.

[Alan Klein]

I should mention the downsides of doing surgery instead of treating it with medicine.  I was very depressed after the surgery even considering suicide for about two weeks.  It could have been the anesthesia after effects that some people react so negatively too.  Friends and family were very helpful during that period.  I really needed their support.    I was in a lot of pain and couldn't sleep in a bed for three months, resting in a recliner an hour or two at a time.  My chest hurt a lot, due to the cutting through of the breastbone for the surgeons to get into my chest..  I couldn;t drive for 6-7 weeks.  It was a very tough period for me.

But after that, things went a lot better.  I'm feeling great.  No more chest pain and the breathing is good.  I lost weight, exercise regularly in a hospital where they montori me on an EKG.  My chest is still numb where they cut the chest bone. Also, my leg is numb where they harvested the blood vessels used to replace the clogged heart arteries.  So there are these downsides as opposed to just doing a change in diet and taking medicine. 

I wanted to mention the down sides as well because it's part of the whole experience and choice people have to make if you're faced with the same decisions I was, hopefully never for my friends here.  "Live long and prosper"

[Bart_van_der_Wolf]

That’s because we don’t have to worry if the death squads will approve the procedure, based on budgetary constraints.

You seem ill informed, or at least that's not how these procedures are carried out in my country. If you need it you need it. No budgetary constraints, that's something for after the procedures are completed. Everybody is insured, so budget is or will be available.

[Alan Klein]

PS:  I think I was still posting here during those first two weeks.  If so I got you guys to thank for getting me through that depressed period as well.  All those arguments may have kept me alive.  So thanks to you too. 

[Bart_van_der_Wolf]

PS:  I think I was still posting here during those first two weeks.  If so I got you guys to thank for getting me through that depressed period as well.  All those arguments may have kept me alive.  So thanks to you too. 

It may create higher bloodpressure now and then though ...

[Alan Klein]

It may create higher bloodpressure now and then though ...

Believe it or not, that's actually good.   The cardio exercises I take is to exercise the heart.  They want me to get my pulse up 30% over its resting rate.  Blood pressure increases as well during this period.  So fighting with you is actually strengthening my heart. Thanks for the exercise. You may be saving my life.

[Alan Goldhammer]

This report demonstrates the importance of doing large long term evaluation trials so that the most cost-effective therapies can be standardized.  The paper does not say that stents are 'useless' and should not be used but rather that for many cardiac patients, pharmaceutical therapy is  as good and has fewer side effects.  One problem with the US healthcare system is the amount of money that is spent on expensive interventions that do not lead to improved health outcomes or better quality of life.  Almost anytime one goes to see an orthopedist about a joint malady an X-Ray is taken even though the diagnostic utility is often nil.  Guess who owns the X-Ray equipment???

[petermfiore]

Personally I thank heart stenting and carotid endarterectomy for saving my life.

Many lives have and will be saved with cutting edge medicine. Thank God for that. For many this disease is genetic issue. But so much of disease can be controlled and avoided with good habits. Not easy but doable, if adopted with a real commitment.

My point being that heart disease and it's causes are and have been well known for awhile now. I have family that have been saved by these procedures.

My now deceased father-in-law had many heart rebuilds, by-passes and an aortic partial replacement. No family history of cardiac issues. His was totally caused by bad habits. All of which were world known for decades. The food he ate and the smoking he did were the cause of his heart issues.
He did as he pleased.

"Science and the Tax payer will take care of it all", was his mantra. He was not alone in his thinking. His three sons are all of the same mindset.
I know many people that would rather under go through these procedures than change their behavior.

I was a type 2 diabetic for a number of years, all weight related. I finally got serious about things and lost 40 pounds. I now have normal blood glucose levels, blood pressure and all that goes with that horrific disease. I was able to drop all the related meds and feel so much better.

We all have a finite time to be what we are. I'm painting today...

Peter

[Slobodan Blagojevic]

... If you need it you need it. No budgetary constraints...

Depends on who determines if you needed it and how long till you get it:

https://www.forbes.com/sites/sallypipes/2019/04/01/britains-version-of-medicare-for-all-is-collapsing/#bcb65c136b89

(Emphasis mine)

Nearly a quarter of a million British patients have been waiting more than six months to receive planned medical treatment from the National Health Service, according to a recent report from the Royal College of Surgeons.

Wait times for cancer treatment -- where timeliness can be a matter of life and death -- are also far too lengthy. According to January NHS England data, almost 25% of cancer patients didn't start treatment on time despite an urgent referral by their primary care doctor. That's the worst performance since records began in 2009. And keep in mind that "on time" for the NHS is already 62 days after referral.

The NHS also routinely denies patients access to treatment. More than half of NHS Clinical Commissioning Groups, which plan and commission health services within their local regions, are rationing cataract surgery. They call it a procedure of "limited clinical value."

Many Clinical Commissioning Groups are also rationing hip and knee replacements, glucose monitors for diabetes patients, and hernia surgery by placing the same "limited clinical value" label on them.

[Alan Klein]

This report demonstrates the importance of doing large long term evaluation trials so that the most cost-effective therapies can be standardized.  The paper does not say that stents are 'useless' and should not be used but rather that for many cardiac patients, pharmaceutical therapy is  as good and has fewer side effects.  One problem with the US healthcare system is the amount of money that is spent on expensive interventions that do not lead to improved health outcomes or better quality of life.  Almost anytime one goes to see an orthopedist about a joint malady an X-Ray is taken even though the diagnostic utility is often nil.  Guess who owns the X-Ray equipment???

The problem with choice is that it's almost impossible for the patient to determine the best course.  Everyone is hitting you with different options.  Reasons to do this or that.  Who do you believe?  The pressure is enormous.  You're trying to predict and calculate the future against each option which is impossible.  How do you gage statistics and possibilities in your own case? The emotional pressure is enormous.  Let's face it.  Fear fogs up most rational thinking.  Whatever you decide, luck plays a huge part. 

[Alan Goldhammer]

The problem with choice is that it's almost impossible for the patient to determine the best course.  Everyone is hitting you with different options.  Reasons to do this or that.  Who do you believe?  The pressure is enormous.  You're trying to predict and calculate the future against each option which is impossible.  How do you gage statistics and possibilities in your own case? The emotional pressure is enormous.  Let's face it.  Fear fogs up most rational thinking.  Whatever you decide, luck plays a huge part.

There is no question that there is a great deal of truth to what you say.  The key thing is to continue the long term research into evidence-based medicine.  The paper under discussion in this thread excluded a lot of cardiac patients from the study as the investigators realized that there were some risk categories that will require intervention and stent implant.  the key outcome is the use of stents should not be considered 'routine' for all cardiac patients.  One of the difficulties with new medical advances is gathering long term outcome evidence.  In my own field of pharmaceuticals there is a considerable amount that we still don't know even about Rx products that have been on the market for many years.  Because we don't have good electronic medical records as many European county health systems do, it is difficult to do this type of outcome research.  One of my last projects prior to retirement was managing what ended up as a $40M research program to come up with better ways of data analysis into drug safety and outcomes.  It was really difficult as we realized from the outset that even common definitions don't exist.  the US systems of records is pretty much focused on reimbursement codes rather than medical outcomes.

[Alan Klein]

Many lives have and will be saved with cutting edge medicine. Thank God for that. For many this disease is genetic issue. But so much of disease can be controlled and avoided with good habits. Not easy but doable, if adopted with a real commitment.

My point being that heart disease and it's causes are and have been well known for awhile now. I have family that have been saved by these procedures.

My now deceased father-in-law had many heart rebuilds, by-passes and an aortic partial replacement. No family history of cardiac issues. His was totally caused by bad habits. All of which were world known for decades. The food he ate and the smoking he did were the cause of his heart issues.
He did as he pleased.

"Science and the Tax payer will take care of it all", was his mantra. He was not alone in his thinking. His three sons are all of the same mindset.
I know many people that would rather under go through these procedures than change their behavior.

I was a type 2 diabetic for a number of years, all weight related. I finally got serious about things and lost 40 pounds. I now have normal blood glucose levels, blood pressure and all that goes with that horrific disease. I was able to drop all the related meds and feel so much better.

We all have a finite time to be what we are. I'm painting today...

Peter

That's good inspiration for others Peter.  The problem for most people is that until something horrible happens, they tend dismiss bad things happening to them from their personal habits, good or bad.  Such as in my case.  The expression is, " Nothing focuses a person's attention like the hangman's noose. "  It was good to hear about how you improve with diabetes 2, something I suffer from.  It probably complicated my heart disease.  So I'm paying more attention, not perfect though.  It's so hard to forgo good food.    I'm also not an exercise buff.  I'd rather stare at a computer screen and type posts than actually move a muscle.  But I have lost 35 pounds and that seems to help but still on medicine.  Just got a 6.4 on my A1C which ain't too bad.  Maybe my heart problem was God's way of telling me to straighten out and fly right.