When Heart Treatment Guidelines Are Not Followed

A recent study published in the journal Circulation noted some disturbing facts about heart treatment guidelines, and the conclusion from researchers can have important health consequences for you. The study found that more than a third of Americans with heart disease may not be getting "guideline-based" treatment for their problem. Researchers looked at patients with coronary artery disease (CAD), also called coronary heart disease, in which plaque builds up inside the coronary arteries, robbing the heart of its blood supply, and found that CAD patients are more often given recommendations for angioplasty and fewer recommendations for coronary artery bypass surgery (CABG) than is indicated by current evidence-based guidelines developed jointly by the American College of Cardiology and the American Heart Association. 

Coronary artery bypass surgery, also called open-heart surgery, is a procedure in which the chest is opened and a section of a healthy blood vessel from another part of the body is rerouted or "bypassed" around clogged arteries to improve blood flow and oxygen to the heart. Angioplasty is a less invasive procedure used to open blocked or narrowed coronary (heart) arteries in which a thin tube, or catheter, is threaded through a blood vessel to the affected area of the heart and a small balloon is inflated to prop open the blockage.

The study researchers wanted to know whether cardiologists were following the guidelines for use of angioplasty and CABG and concluded that the answer more often than not was "no."  Edward L. Hannan, Ph.D., professor of Health Policy, Management and Behavior at the State University of New York in Albany, and his associates looked at data gathered between 2005 and 2007 at 19 hospitals in New York State involving over 10,000 patients treated for CAD.  They then compared the treatment guidelines called for according to the patient's medical status with the treatment recommended by the physician. They found that 94 percent of the patients for whom angioplasty was indicated by the guidelines were recommended for angioplasty, but only 53 percent of patients for whom the guidelines called for CABG were recommended for the procedure; 34 percent of these patients were recommended for angioplasty.

The findings, say the researchers, are important because recent studies show that CABG surgery outcomes are superior to angioplasty outcomes for some patients

If you have coronary artery disease, ask your doctor if medication and lifestyle changes are sufficient to alleviate the problem. If not, ask which procedure, angioplasty or CABG, is right for you and why.