How will medical groups and insurers react to the recent JAMA study showing that a significant percentage of electively implanted angioplasty devices may be overused?
Another day, another study showing that invasive cardiologists overuse angioplasty and insert unneeded stents in patients without acute symptoms of coronary artery disease.
The latest study, which appeared in today's Journal of the American Medical Association, deemed 15 percent of the 600,000 angioplasties done every year are either inappropriate or their necessity is uncertain.
Since the COURAGE trial results were released in 2007, cardiologists have known that drug intervention (primarily statins) works just as well or better than angioplasty in patients with stable coronary artery disease (cost: $1,000 a year or less if generics are used compared to $20,000 for the stent operation).
A study that came out two months ago showed there had been no change in cardiology practice in the wake of the COURAGE trial. This latest study confirms that invasive cardiology is largely an evidence-free zone where the self-interest of the surgeons and the hospitals trumps the needs of patients, who have no clue as to what's going on. "Thank God the doctor did that operation. I could have died tomorrow."
Dr. Mark Midei, the Maryland cardiologist once feted by Medtronic with a pig roast for inserting 30 stents in a single day, remains the poster child for invasive cardiology overutilization. His story was the subject of a Congressional investigation, and is repeated in today's Wall Street Journal (subscription required).