Slow and steady can win the race in cardiac treatment
Recent research has shown some patients can do just as well with medication route as when electively undergoing angioplasty
By Arthur Hsieh
Editor's note: Recent research has shown some patients can do just as well on medication as with angioplasty.
At the heart of this article is the confluence of science, perception and money.
For the past decade we have been framing the concept of emergency cardiac care around the end point of angioplasty. Studies pointed toward the efficacy of the procedure, and over time, the concept worked its way through the entire population of real and potential cardiac patients.
As this study points out, more recent research has shown the subset of stable cardiac patients who can do just as well with a lower-cost, slower-acting medication route rather than electively undergoing the surgical procedure.
Despite the data, the rate of angioplasty continues to be significant, at greater risk and cost to the patient, health insurers and ultimately, taxpayers. It's not surprising, given medicine's generally conservative approach to change.
There are implications for today's EMS systems that have implemented cardiac care and destination guidelines. We may need to become more precise in the way we assess and manage our cardiac patients in order to reduce the rate of "false positives."
This will run counter to EMS providers who have been trained to transport to a STEMI receiving center if there is even a remote chance of one. Most of us have seen patients who fit this profile, so we may not realize that the cost of playing it safe may not outweigh the risk to the patient as well as additional cost.