Early and aggressive treatment of common but serious heart problems yields better results for patients and cuts costs for healthcare providers, according to two studies unveiled last week.
The first suggests that liberal use of coronary stents-the expensive metal scaffolds used to prop open blocked arteries that feed the heart-reduces patient deaths and complications significantly while trimming total treatment costs by reducing rehospitalizations.
The findings support cardiologists' near infatuation with stents, which are implanted in more than 70% of the 500,000 patients who undergo angioplasty each year.
The second study suggests that prompt diagnostic angiography followed by angioplasty or bypass surgery to treat patients with unstable angina or a common form of mild heart attack beats medicine and watchful waiting.
Both reports, presented at the American College of Cardiology scientific meeting in New Orleans last week, challenge hospitals to consider intensifying their treatment of some of the most frequent acute heart conditions.
"These studies demonstrate the importance of looking at the total cost of care over the course of a disease state," said David Shulkin, M.D., chief quality officer at University of Pennsylvania Health System, Philadelphia. Otherwise, he warned, "it often appears that more-intensive interventions are added cost without added benefit" when the opposite is true.
The stent study, headed by Douglas Weaver, M.D., of Henry Ford Health System in Detroit, was conducted to determine whether doctors should use stents routinely or only as a second line of attack.
In the stent study, 479 patients at 44 medical centers in the U.S. and Canada were selected randomly to receive stents as primary treatment or only when necessary after an imperfect angioplasty. At six months, the rate of death, heart attack and a secondary procedure, such as bypass surgery, was 6.1% for the group that had stents from the start compared with 14.9% for the provisional group.
In the angiography study, based on care of 2,456 patients at Swedish hospitals, aggressive treatment reduced deaths and serious heart attack by 21% and rehospitalizations by 50% compared with the conservative approach.