June 8, 2009
Is Angioplasty Worth The Risk?
Though A Common Medical Procedure, Many Are Performed At Hospitals Unprepared If Something Goes Wrong
-
Play CBS Video Video Angioplasty Doubts Angioplasty is a very common medical procedure. However, recent studies have cast doubts on its benefits. Could too many people be getting angioplasty? Dr. Jon LaPook reports.
-
During angioplasty, a clogged blood vessel feeding the heart can be opened up with a tiny balloon and a stent placed to keep it from closing. (CBS)
-
Interactive Heart Disease In The U.S. A look at state-by-state estimates of the prevalence of heart disease.
In 2006, Scott Sullivan's mother, Pearl, went to Holy Name Hospital in Teaneck, New Jersey for a heart test to see what was causing her shortness of breath. She never came home.
"I went to the nurse's station and asked, 'Where's my mom?' And you could just tell by the look on the nurse's face that my mom's not alive," Sullivan recalled. "They punctured the artery, and my mom died because of it."
"Have you figured out what happened?" asked LaPook.
"I know what happened in my heart. I don't know in doctor terms," he said. "But they botched the angiogram, the angioplasty."
During angioplasty, a clogged blood vessel feeding the heart can be opened up with a tiny balloon and a stent placed to keep it from closing. It's a relatively safe procedure, but about one in 200 patients dies after non-emergency angioplasty.
Pearl Sullivan's family alleges in a lawsuit they did not know the hospital had no on-site cardiac surgical back-up to handle the rare cases, about two to three in a thousand, when something goes wrong and doctors need to operate.
"We think that they're equipped to do whatever's necessary," Sullivan said. "And apparently not."
In the case of Pearl Sullivan, Holy Name said: "We are confident the evidence will show the doctors, staff and hospital acted appropriately and that this death was unrelated to the absence of on-site cardiac surgery."BusinessWeek.com: Another Blow for Angioplasty
Three prominent cardiology groups - the American Heart Association, the American College of Cardiology, and the Society for Cardiovascular Angiography and Interventions - say non-emergency angioplasty should only be done with cardiac surgical support on-site.
So why is the procedure still so common in small hospitals?
"Hospitals are competing to establish services which duplicate services right next door," said Dr. Elliot Fisher of the Dartmouth Medical School. "Not to the benefit of the population, but to try to preserve their financial margins. We have a medical arms race going on in this country."
Angioplasty is big business. At about $16,000 a procedure, it's a roughly $21 billion-a-year industry.
"Cardiovascular interventional procedures are big moneymakers for hospitals and for practitioners," said Dr. Steve Nissen of the Cleveland Clinic. "It's tough to walk away from that for a lot of people."
Dr. Paul Mendelowitz at Holy Name says money is not a motivation.
"What I'm telling you is that at no time, did I ever hear, 'We've gotta get into the angioplasty business because there's money to be made here,'" he told LaPook. "That was not the driver. I think the ability to do both emergency and non-emergency angioplasty allows labs to raise their quality because their volumes are higher."
Holy Name performs elective angioplasty without surgical backup as part of a closely-supervised study in 45 hospitals testing whether it's safe.
Why would somebody elect to go to a hospital that doesn't have surgical backup, versus one that does?
"Because Holy Name is their hospital," said Dr. Mendelowitz, "and they've been coming here. And maybe their parents came here. And maybe they bring their kids here. And their doctors are here."
Many experts say too many angioplasties are already being done.
"It's markedly overused," said Dr. Fisher. "Probably 40 percent of the procedures are unnecessary."
He says if patients fully understood the risks and benefits of the procedure, fewer people would have it done, let alone at a hospital without surgical back-up.
Studies show medication can be just as effective as angioplasty in patients who are not showing signs of a heart attack.
"I can tell you this," Dr. Nissen said. "If I needed a heart catheterization, and an angioplasty, I'd have it done in a major medical center. I certainly wouldn't have it done in a small community hospital, where there was no surgeon, there was no back-up."
Scott Sullivan said his family needs answers: "Why, what, when it went wrong? What time did it go wrong? Did they, for three hours were they playing around in there, trying to fix something that they weren't equipped to do? My family needs answers."
Pearl Sullivan signed a consent form both for the procedure and to participate in the study of angioplasty without surgical backup. But her family doesn't believe she understood what it meant.
Tomorrow: A look at the issue of "informed consent" - what you need to know before you agree to a medical procedure.
For more info:
© MMIX, CBS Interactive Inc. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed.
More From CBS Evening News
Add a Comment See all 28 Comments
- Katie, Iam writing to you, regarding your program, on 06-08-09, on angioplasty procedures. This program, hits home, with me, since, my sister, was admitted, to a local hospital, on 11-06-08, for two procedures, the next day, the second procedure, was the stent placement, she did not survive this procedure, they perforated the vena-cava artery, the sac around her heart, filled with blood from the perforation, and stopped her heart. Unlike, the people in your program, whom I sympathize with, and my heart goes out to them, I was unable to retain legal representation, on her behalf. My financial situation , as such, is to be able to obtain, legal representation, on a contingency basis. They will only take the case, only, if they are sure, they will win. She did sign a consent, for the procedure, and this, was one of the negative factors, in taking her case. The doctors, and hospitals, do not emphasize, the seriousness of this procedure, even tho', it is all written on this consent form, which is to protect the doctors and the hospitals, and it does!!! We put ourselves, and our loved ones, in the hands of these professionals, to make us better , and when, they are successful, they are "glorified", and when it doesn't, because of their mistake, or mistakes, "oh well", sorry, can't tell you what happened!! That is, about all the emotional response and compassion that you receive from the doctors, and hospital . This is an injustice, in our medical system. If we cannot get legal representation, for the loss of a loved one, what are we to do!!!!!!!
- Reply to this comment
- Friday, August 13,1998 I was having a stint in one blocked artery in a large hospital in Little Rock, AR. The doctor came out during the procedure and told my family that I needed open heart surgery and that it was a matter of life and death. He came back a short time later and said there were no heart surgeons available. He returned to surgery and continued to save my life by putting three stints back to back (which is said to be a No No!). The main left artery had been ripped. One of the assisting doctors told me the next morning that he had left out of surgery because by rights I should be dead! The three stints began to close down three months later and I had to have four bypasses because the stints were blocking other arteries. While waiting to be put to sleep before the stint I could hear the doctor talking about how fast he was at getting in and out . The heart surgeon told me I had extra small arteries. Doctors should slow down in performing this because each patient is different.
- Reply to this comment
- My name is Debbie, I'm a single mother of four. I just had my seventh cardiac catherization done Wednesday. I had my first open Heart done 23 years ago it' was called atreial septal defect( I had a whole the size of a fifty cent piece between my left and right atrium. They placed it with a dacron patch). Sept 11 2003 I had my first defib/pacer
put in. All the wires and defib/pacer were on the recall list. So April 14, 2006 it was replaced. Except the wires. Now I'm having my Mitro valve replaced because it is totally
desrtoyed. So at the age of 43 It's time again. I trust my new Dr.s. They are well known and respected. S wish me luck. Tomorrow they give me the date.
My oldest son has to come home from the military(Army) to help out.
So to all of you relax! If I've come to terms and am fine so should you. - Reply to this comment
- Dear skeezix06
I beg to differ with you sir: There is a certain Medical Center in Duarte Ca. that cares for cancer patients They are a world class hospital that gives patients care on individual needs. It 's like a whole city. They give the patients a lot of hope.
I have never seen such caring doctors and nurses in my life. And thanks be to them I still have a life. - Reply to this comment
- This is about standardization of care. It is about guidelines that you as a patient must meet before they agree to do anything for you. It is not that much about giving care that is based on individual needs. Hospitals have regular reviews of procedures and things like unnecessary operations are on that list. I'm surprised Dr. LaPook forgot to mention it.
- Reply to this comment
- Hey vgbledblabl ~~ Ah done tol you git back on yo meds ! an quit writin all that trash ---ROTFLMAO-------
- Reply to this comment
- Here's what I know as it relates to angioplasty with off-site surgical backup.
1.) Angioplasty in the setting of an acute myocardial infarction that is due to an occluded coronary artery saves lives. The quicker it can be done, the better. Less than ninety minutes is the goal for "door-to-balloon time".
2.) Not everyone has a tertiary hospital with (good) cardiac surgical services within 90 minutes of where they have their myocardial infarction.
3.) There is no longer such a thing as routine surgical standby, even at the biggest and best hospitals. Cardiac surgery resources are more likely being utilized for other patients at the time of a catastrophic event during angioplasty.
4.) Many cardiac surgery training spots have not filled over the past few years which means fewer cardiac surgeons in the pipline and, perhaps, less talented surgeons as the end product.
5.) In order to provide angioplasty when it is life-saving, proficiency needs to be maintained by performing non-emergent cases.
6.) Only one study has suggested that angioplasty with off-site surgical backup is unsafe and the true predictor of bad outcomes was low-volume. This is why #5 is so important.
7.) Numerous studies with a cumulative experience of of over 55,000 patients have been reported on in the literature suggesting angioplasty with off-site surgical backup is safe and the need for emergent surgery is rare.
8.) If you need emergent surgery after a complication from angioplasty the outcome is likely to be bad no matter where you have it done.
9.) Drs. Fisher and Nissen work in institutions that enjoy the same profit margins as centers without surgical backup so volume lost to community hospitals adversely affects the bottom line at their institutions. The financial argument can be used both ways.
10.) In forming the Coalition of PA Hospitals performing coronary Revascularization with off-siTe surgical backup (C-PART) and as a doctor who performs angioplasty with off-site surgical backup, I can attest that profit is not the driver.
I empathize with Ms. Sullivan's family. Unfortunately a policy that jeopardized a program that safely performs PCI with off-site surgical backup may result in unnecessary deaths. - Reply to this comment
- One of the major problems with all cardiac testing of procedures is that it is done on men! Until there are an equal number of women included in testing we will not have accurate information (about testing). Why would anyone have ANY kind of procedure done at a hospital that did not have surgery available for complications?
- Reply to this comment
- One of the major problems with all cardiac testing of procedures is that it is done on men! Until there are an equal number of women included in testing we will not have accurate information (about testing). Why would anyone have ANY kind of procedure done at a hospital that did not have surgery available for complications?
- Reply to this comment
- As a physician, we are trained never to perform a procedure if we cannot address every possible complication of that procedure. It's a simple rule that saves lives. The "you can get hit by a car by walking across the street' argument just doesn't fly in this case. Damage to the coronary artery is a known and not infrequent complication of angioplasty, and this potential complication must be addressed prior to the procedure being performed. I agree that when hospitals perform angioplasty without surgical back up, the decision is being made with profit in mind and it needlessly puts the patient at risk.
- Reply to this comment
Author Thomas Friedman on Obama's Afghanistan plan and the war on terror.
