After another study was released indicating that cardiac stents are not as effective as alternative forms of treatment, it got me wondering if we're getting to the point where stent implantations should be actively limited in some way.
The latest study I'm aware of suggesting that stents should not be the treatment of first choice was presented at this week's American Heart Association annual meeting in Dallas, and was published in the New England Journal of Medicine.
The study may have gotten lost amid the controversy over the association's risk calculator that it produces with the American College of Cardiology, but the stent study's conclusions are of interest. It found that stent implantation in kidney arteries performed no better than aggressive drug therapy, according to this Bloomberg article.
The journal also published an editorial on the subject that is quite damning of the use of stents in these circumstances. The 10-year trial "establishes beyond a reasonable doubt that renal-artery stenting is futile for the target population enrolled in the study," said Dr. John Bittl, from Munroe Regional Medical Center in Ocala, Fla., as quoted in Bloomberg.
Bittl urged additional studies of a different population.
Maybe, given the current desire to cut costs and improve quality in health care, this is a situation where an influential group should step in and urge the industry to cut back on stent usage. There's money to be saved in coronary stents. One estimate put the market for stents in the United States at $2.8 billion in 2011, and it was expected to grow to $4.3 billion by 2016.
After all, the renal study's conclusions echo similar findings regarding the use of stents, such as one looking at adults with diabetes and heart disease and another in reducing arterial pain.
I'm not suggesting that health care executives bypass the normal course of science, but the studies showing that stents work better are difficult to find.
The American College of Cardiology published appropriate-use criteria for coronary revascularization in 2012 that in my reading gives lukewarm backing of stent usage, known as percutaneous coronary intervention, rating it as appropriate in selected circumstances only.
Certainly physicians can use the methods they think are best, but sometimes they need to be told what to do. I'd like to see a qualified group weigh in with an actual recommendation of whether PCI is recommended or not.
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