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

Editor’s Note:

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.

About the author

Art Hsieh, MA, NRP teaches in Northern California at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. An EMS provider since 1982, Art has served as a line medic, supervisor and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook writer, author of "EMT Exam for Dummies," has presented at conferences nationwide and continues to provide direct patient care regularly. Art is a member of the EMS1 Editorial Advisory Board. Contact Art at and connect with him on Facebook or Twitter.

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