Study Points to Overuse of Angioplasty Procedure as Elective Treatments

A new Journal of the American Medical Association study has found that angioplasties are misused in more than one-tenth of patients undergoing elective treatment, highlighting concerns that physicians are prescribing too many big-ticket medical procedures, Reuters reports.

U.S. hospitals perform roughly 600,000 angioplasty procedures per year, which cost approximately $12 billion and provide few benefits for many patients, Reuters reports (Joelving, Reuters, 7/5).

Study Methodology

For the analysis -- which is the first to consider whether angioplasty procedures meet guidelines for appropriate care -- St. Luke's Mid America Heart Institute researchers and colleagues examined data for more than 500,000 patients treated at 1,091 hospitals between July 2009 and September 2010 (Fay Cortez, Bloomberg, 7/5).

The researchers then compared the data with guidelines developed by multiple medical groups in 2009 to determine whether hospitals were appropriately administering the procedure, in which stents are used to clear blocked arteries (Reuters, 7/5).

Key Findings

According to the study findings, approximately 70% of angioplasties were conducted on heart attack patients who had an urgent medical need. Researches deemed about 99% of such procedures as appropriate (Bloomberg, 7/5). However, about 30% of angioplasties were performed on patients with mild or no symptoms, according to the researchers, who deemed 12% of such operations as inappropriate and 38% as having an uncertain benefit (Winslow/Carreyrou, Wall Street Journal, 7/6).

The study also identified wide variation between hospitals' procedure rates. For example, in 25% of hospitals, less than 6% of stenting surgeries were inappropriate, while in another 25% of hospitals, more than 16% of such procedures were unnecessary (Reuters, 7/5).

According to Dr. Paul Chan, a cardiologist at St. Luke's and the study's lead author, "part of the [problem] may be driven by a huge push for screening patients who don't have symptoms but have risk factors for disease" (Wall Street Journal, 7/6).

According to study co-author John Spertus, the findings present "an opportunity for hospitals to reflect on their decision-making process and consider if some of the patients they treat with angioplasty might be better treated with medicines" or a coronary artery bypass graft (Bloomberg, 7/5).  

Scrutiny of High-Cost Procedures

The results come amid increasing scrutiny of high-cost medical procedures, which some experts argue are overused, the Wall Street Journal reports.

For example, the Spine Journal last week published an analysis that examined whether spine surgeons failed to report serious complications during clinical trials of a bone growth drug (Wall Street Journal, 7/6).