Monday, February 26, 2007

Heart Disease: Why Are We Not Talking Enough About Non-surgical Treatments?

A Feb 25, 2007 The New York Times article discusses two treatment options for blocked heart arteries- stents and bypass surgery (CABG). Some of the points made are:
- The number of bypass surgeries has gone down while the number of stent procedures has gone up over the years.
- One of the possible reasons cited for lower number of bypass surgeries is cardiologists not consulting surgeons before treating blockages with stents.
- The recognition of previously unknown complication of new stents-late stent thrombosis- may make bypass surgery an attractive option for more patients.
- The cardiologists say that some surgeons refuse to operate on sicker patients for the fear of adverse effect on their performance statistics. The performance statistics for individual surgeons are made public in some states.

In this article, Barnaby J. Feder writes about an issue that is commonly discussed- and argued about- among cardiothoracic surgeons and cardiologists. There are heart blockages that are clearly suitable for stent placement (performed by a cardiologist), and there are those clearly suitable for bypass surgery (performed by a surgeon). In addition, there is a gray area that is source of discussion between cardiologists and cardiothoracic surgeons. Of late, the cardiologists have taken over more of this gray territory.
At times, the argument between bypass surgery and stents can relegate non-surgical treatment measures to the background.

Pro-Per™ Points

A. Whenever blockage of heart arteries is diagnosed, some patients feel let down if they are told that their blockage will not and should not be fixed with stents or bypass surgery. The physicians at times also feel nervous about not fixing the blockage that they see. This happens despite the fact that research supports non-surgical management in many of these cases. This happens because we do not talk enough about the following:

- Whenever we notice any heart artery blockages, we are afraid that these blockages may cause heart attack. We used to think that blockages turn form 50 to 60 to 70%...eventually turning into 100%- causing a heart attack. The studies now suggest that majority of heart attacks happen at locations in the heart arteries that have less than 50% blockage- the extent of blockage that can easily be missed or deemed unimportant on a stress test or an angiogram. So while the tighter blockages may scare us more, the minor blockages are the ones that make us more vulnerable to dreaded heart attacks. This brings us to the next point.
- The heart artery blockage is the presenting symptom of body’s diseased plumbing system. It needs to be seen and treated as a systemic disease. Not all blockages need to be fixed surgically. Without regards to how these blockages are tackled (with or without surgery), attention to whole plumbing system of the body is most important aspect of the management. This includes medications and management of risk factors. These measures decrease the chances of various diseases of plumbing system: stroke, heart attack, peripheral arterial disease (P.A.D.). A person with heart attack is at a high risk for stroke and vice versa.

B. Anytime we discuss the treatment of heart artery blockages, non-surgical treatment methods including medicines, exercise etc. need to be given well-deserved place of pride along with other treatments.
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