Prescription drugs can be as effective as trying to snake a stent into a clogged artery for some heart attacks, according to a Duke University report
19 02 09 - 12:20
Drugs can save hearts and cash
Sarah Avery - Staff Writer - The News & Observer
It's much cheaper and just as effective to treat some heart attacks with drugs instead of also trying to snake a stent into a clogged artery, scientists at Duke University report today in the New England Journal of Medicine.
The findings could prompt significant savings for many of the estimated 1.2 million Americans who suffer heart attacks each year. Wire mesh stents open clogged arteries and can save lives when used within a few hours of a heart attack, but they're no more beneficial than clot-busting drugs alone if the attack occurred a day or so before the patient sought treatment.
Forgoing stents in those cases could save an average of $7,000 per patient -- or $700 million for the estimated 100,000 U.S. heart attack patients who don't need them.
Those kinds of savings are key components of President Barack Obama's stimulus plan. Included in the legislation is more than $1 billion to enhance the science behind medical practices, which often favor technology and high-priced interventions over less-expensive approaches such as drugs, even though the health benefits are unknown or dubious.
Though breakthroughs in new drugs, devices and surgeries have contributed to a longer life expectancy in the United States, they haven't come cheaply. Spending on health care in the United States tops $2 trillion a year and has risen nearly 10 percent annually since 1970.
"We need to put more resources into research to know what works and doesn't work for same medical conditions," said Joel Miller, senior vice president for operations at the National Coalition on Health Care, a Washington health advocacy group. "Physicians and patients need better data, and this is a case in point."
Stenting is a potentially life-saving procedure when a patient arrives in the emergency department in the throes of a heart attack. Routed with a catheter up a large blood vessel in the groin, the wire scaffold is expanded in the blocked artery by a small balloon, restoring blood flow and keeping vital heart tissue from dying.
Scanned and stented
Dr. Michael Durfee, 71, a retired pediatrician in Raleigh, said he had chest pains about six weeks ago that he at first ignored. When the pain persisted the next day, his wife drove him to Rex Hospital, where he was immediately scanned, stented and admitted for two days. He said the treatment was life-changing.
"I really feel good now," Durfee said, noting he goes to cardiac rehabilitation three days a week and has begun attending a support group.
But too many heart attack patients wait much longer than Durfee, who kicks himself for not recognizing the pain in his left chest was more than a pulled muscle from loading groceries. When patients don't seek care for days or weeks, a blocked artery can do irreversible damage to the surrounding heart tissue.
Stenting doesn't help in these cases, but doctors and patients alike often choose to implant a stent anyway.
"The thinking was that the heart might still be happier if it had another big pipe of blood flow, even though that part of the heart was not coming back," said Dr. Daniel Mark, lead author of the Duke study.
Research that Mark and others published two years ago disproved that notion. They showed that clot-busting drugs alone provide just as much health benefit to these patients as stents and drugs together.
Now the recent findings add a cost benefit to using drugs alone.
Mark and his team followed a subset of the original 2,100 study participants for an additional two years. Overall, patients who got stents stayed in the hospital 1.2 days longer than those who just got medicine. For the stent patients, the average cost of care during the first 30 days of treatment was $22,859, compared with $12,683 for the drug therapy group. After two years, the cost difference narrowed, but it still amounted to an average $7,000 savings for the drug-only patients.
Dr. Deepak Pasi, a cardiologist with Carolina Cardiology Consultants, said the study's findings reinforce the need to treat patients individually based on their unique circumstances, rather than follow a universal menu.
"There are several scenarios, and each is treated differently," he said. The bottom line, he said, is intervening early and appropriately.