Most heart patients confused about stent benefits

A new study published in the Annals of Internal Medicine reveals yet another stunning disconnect in physician-patient communication. In this case, the heart patients at Baystate Medical Center in Springfield, Mass., almost all thought the stents used to prop open their arteries would prevent a heart attack--even though doctors had told most of them before the procedure that it would do nothing more than relieve chest pain.

For the study, Baystate's Michael B. Rothberg, MD, and colleagues analyzed questionnaires collected from 153 patients receiving elective coronary catheterization and possible percutaneous coronary intervention (PCI) between Dec. 1, 2007, and Aug. 31, 2008. Additionally, 10 interventional cardiologists and 17 referring cardiologists responded.

When asked whether they thought procedures could prevent death or heart attack, more than 80 percent of patients believed their chances of having a heart attack or dying from a heart attack would go down if they had the procedure, while a comparable percent of the cardiologists said they believed that angioplasties and stents only alleviate chest pain in these patients.

"This is not a cardiology issue; this is a medical issue," Dr. Marc J. Schweiger, a Baystate cardiologist and senior author of the study, told the Boston Globe. "I suspect if you looked at any procedure you would find the same results. Doctors think they explain [them] to patients, and patients for variety of reasons are misinformed."

Many experts blame flaws in the informed consent process for the communication gap.

"It's important to incorporate decision aids or educational material so that patients at least get a brochure outlining the risks, the expected benefits and others that are not expected benefits," Alicia Fernandez, MD, of the University of California, San Francisco, told Cardiovascular Business News.

But most challenging, Fernandez said, would be changing the reimbursement system to alter the context in which medical decisions are made. "Currently, any decision process is going to favor doing the procedure and I think this is where we need to have a better alignment between reimbursement and high-quality care."

To learn more:
- read this article in the Boston Globe
- see this piece in Cardiovascular Business News
- check out the abstract from the Annals of Internal Medicine

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