Patients expect their doctor to provide them with all the information necessary to make educated decisions about their health. However, questions have been raised about whether cardiologists sometimes overstate the benefits of an invasive procedure for chronic angina.
Angina leads to chest pain when there is a lack of oxygen-rich blood in the heart due to clogged arteries. An invasive procedure, called a percutaneous coronary intervention (PCI), is sometimes used to alleviate symptoms when X-rays reveal clotting in an artery. A small metal device called a stent is inserted into the heart to keep the artery open. It is thought to improve the symptoms of angina faster than medication, but evidence suggests that when angina occurs predictably, PCI does not reduce the risk of death or heart attack.
Despite the evidence, many patients with stable angina think that PCI does lower the risk of heart complications. Three studies published in JAMA Internal Medicine try to uncover why this is happening. The first study, conducted at Tufts University School of Medicine analyzed the conversations between 20 cardiologists and 40 of their patients about their stable angina. The study found that only two doctors told patients that their angina would be improved, but would not reduce the risk of a myocardial infarction or death. According to the study authors, many cardiologists took control of the decision and failed to discuss all risks, while several explicitly or implicitly overstated the benefits.
In the second study from the Cleveland Clinic in Ohio, volunteers were given one of three descriptions of the risks and benefits of PCI for stable angina. One had no information about the effect of PCI on heart attack, one said PCI will not reduce the risk for heart attack, and the last one explained why PCI does not reduce the risk. The researchers found that when the risks were not disclosed, people were most likely to choose to undergo PCI and believed that the procedure would help to prevent heart attacks. They also found that 30 percent of the subjects who were told that PCI would not prevent a heart attack still believed that it would, and many people falsely believed their physician had said that PCI would eliminate the risk. The data showed that when patients understood that PCI would not prevent a heart attack, they were more likely to opt for medications.
The third study from the Veterans Affairs Eastern Colorado HealthCare System in Denver analyzed records from the Cardiovascular Data Registry to show that when X-ray imaging, called angiography, was done for patients without angina symptoms, the likelihood that the PCI would be done inappropriately increased. From this study, the head researcher concluded that “future studies need to define the aspects of care delivery that lead to optimal patient selection for coronary angiography and PCI.”
The studies all had a basic undertone that highlight a patient-physician disconnect. The studies concluded that cardiologists must make sure that their patients have a clear understanding of the procedures they are opting to undergo and the risks associated with them. Patients will likely benefit from asking if their health histories have been factored into the procedure recommending process, what the risks and benefits of the procedure are, what medications will need to be taken, and about alternatives before opting for an angiography or PCI.
If you or a loved one experienced serious complications as result of an unnecessary procedure, contact the experienced medical malpractice attorneys at Lopez McHugh, LLP to discuss your legal options. There is no cost or obligation for the initial consultation and your information will be kept confidential.
