Half of cardiac stent procedures overused, unnecessary

Half of elective surgeries to implant cardiac stents may be unnecessary and inadvertently causing patient deaths, according to an in-depth investigative report by Bloomberg.

Seven million Americans have undergone the popular practice--implanting stents to open blocked arteries--at a cost of more than $110 billion in the past decade, Bloomberg reports. When used to restore blood flow in heart attack patients, the procedure proves beneficial. These acute cases account for half of the 700,000 stent procedures in the United States each year, according to the article.

But after combing through thousands of pages of court documents and regulatory filings, reviewing more than a dozen medical studies, and conducting interviews with 37 cardiologists and 33 heart patients or their survivors, Bloomberg concludes this go-to treatment is often overused, resulting in death, injury and fraud.

The problem stems in the country's payment system that rewards doctors based on volume of procedures rather than quality of care, according to the article. Cardiologists get paid less to talk about the risk of the procedure and alternative treatments than they do for implanting the device.

"Stenting belongs to one of the bleakest chapters in the history of Western medicine," Nortin Hadler, a professor of medicine at the University of North Carolina at Chapel Hill, told Bloomberg. Cardiologists he said, continue to conduct these procedures because the "interventional cardiology industry has a cash flow comparable to the GDP [gross domestic product]  of many countries" and doesn't want to lose it.

One of the more famous cases of stent overuse occurred at one of Maryland's top cardiac-care hospitals after an internal review prompted by a federal investigation in 2009 determined hundreds of patients had unnecessary coronary stents implanted in their arteries, possibly as part of an insurance fraud scheme. Mark Midei, the former cardiologist at the center of the case, filed a defamation suit against Maryland's St. Joseph Medical Center, but a Baltimore County Circuit Court judge dismissed the case in April.

Despite these cases, a recent study in the New England Journal of Medicine indicates implanting multiple, preventive stents when a patient succumbs to heart attack produces a better outcome than only one stent. Researchers recruited 465 patients between 2008 and 2013 and found that patients who had preventive stents had a reduced chance of death by 64 percent over the next two years, versus patients who only received a stent in the offending artery. Those same patients also reduced their chance of having a second major heart attack or severe angina episodes over the same period, FierceMedicalDevices previously reported.

For more:
- read the Bloomberg article