Many Heart Patients Place False Hope in
WEDNESDAY, Sept. 8 (HealthDay News) -- Many heart patients
harbor the misguided notion that angioplasty, a common procedure to
open clogged arteries, will also cut their risk of heart attacks
and death, a new study shows.
In fact, the evidence suggests that angioplasty only reduces
angina (cardiac-linked chest pain) in stable heart patients --
people whose condition has not changed recently and who are not
experiencing a heart attack. The procedure does not reduce the risk
of heart attack or death for these patients.
However, the new study found that 88 percent of stable patients
who underwent angioplasty at a hospital in Massachusetts thought
the procedure would reduce their risk of heart attack. And
two-thirds of the patients didn't even suffer the kind of pain that
angioplasty would likely remedy, the study authors noted.
Furthermore, most patients stuck to their beliefs even after
spending time with a cardiologist who explained the risks and
benefits to them, and had them sign an informed consent form prior
to the angioplasty.
The study "shows the disconnect between what doctors know and
what patients understand. In order to have real informed consent,
patients have to understand not just the risks, but also the
benefits of whatever treatment is proposed," said study author Dr.
Michael Rothberg, of the Division of General Medicine and
Geriatrics at Baystate Medical Center in Springfield, Mass.
The findings were published in the Sept. 7 issue of the
Annals of Internal Medicine.
During angioplasty, a tube is inserted at the groin and snaked
up to the affected artery, where a balloon opens the blockage. A
stent (a flexible mesh tube) is often left in place to help prop
open the artery and maintain blood flow. Angioplasty involves some
risk but the rate of death during the procedure is less than 1
percent, experts note.
In the study, patients underwent catheter-based diagnostic
procedures for a variety of reasons including a positive stress
test, shortness of breath, a previous heart attack or other heart
Angioplasty is often performed at the same time if a blockage is
found. Patient-informed consent for both procedures was
The study involved 153 patients with stable heart disease who
had varying levels of symptoms. According to the authors, less than
one-third (31 percent) of those who agreed to undergo elective
cardiac catheterization had the type of activity-limiting angina
pain that angioplasty might be expected to ease.
Nevertheless, almost three-quarters of all the patients still
believed that if they didn't undergo angioplasty, they would suffer
a heart attack within the next five years.
In contrast, 63 percent of cardiologists surveyed in the study
realized that for stable heart patients, the procedure mainly
reduces pain (from angina) and improves quality of life.
The authors also noted that these benefits can often be achieved
with medication alone.
Only patients who are actually
having a heart attack or coronary event can expect a reduced
risk of future heart attacks and death from angioplasty, according
to prior research cited in the study.
The number of angioplasties done for stable heart patients has,
in fact, decreased lately, said Rothberg. According to the American
Heart Association, about 1.3 million such procedures are done in
the United States each year.
Dr. Henry H. Ting, associate dean for quality, and professor of
medicine at the Mayo Clinic in Rochester, Minn., said he was not
surprised by the study findings.
Ting pointed to a survey at the Mayo Clinic that found that 80
percent of patients signed consent forms they had not read, and did
not know the benefits or risks of the treatment they were
Ting, who conducts research on informed consent, said the
problem of patient understanding isn't limited to angioplasty but
is common in many areas of medicine.
"We [doctors] don't do a good job of knowledge transfer in a way that patients and family members can understand," said Ting. "Graphs and charts are not going to work for many of our patients."
One reason for patients' misunderstanding is the common belief,
cited in the study, that if a treatment is offered, it must have
And Dr. Gregg C. Fonarow, associate chief of the division of
cardiology at the University of California, Los Angeles School of
Medicine said that, "it's not counterintuitive for patients to
conclude" that if angioplasty widens an artery it will reduce the
risk of heart attacks and death, even though it is not true.
Fonarow, who is also professor of cardiovascular medicine and
science at the school, contends that "the importance of this study
is not that the patients should not have had the procedure."
Instead, he said, the study highlights the different perspectives
of doctors and their patients.
Find out more about angioplasty at the
U.S. National Heart Lung and Blood Institute.
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