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July 10, 2011

Authors of a new study estimate that each year as many as 15,000 patients in the United States undergo angioplasties that they do not need, costing $300 million dollars.

Angioplasty, also called percutaneous coronary intervention, is a medical procedure used to widen a narrowed or blocked artery in the heart. Yearly, more than 600,000 patients in the United States undergo an angioplasty. It can be a life-saving procedure for some patients.

Researchers studied data from the National Cardiovascular Data Registry for patients who had an angioplasty between July 2009 and September 2010 to determine the appropriateness of the procedure for each individual.

Those angioplasties deemed appropriate met criteria established by the American College of Cardiology that the patient had a definitive or probable benefit such as increased survival or symptom relief. Researchers deemed some angioplasties “uncertain” because there was insufficient data to conclude whether it was beneficial. Inappropriate angioplasties were those unlikely to increase a patient’s life span or make them feel better, and may even be harmful.

“When an angioplasty was performed in an elective, non-emergency setting, 50 percent of angioplasties were considered appropriate using these criteria, while 38 percent were uncertain (meaning that more research is needed to know if they are beneficial or not) in appropriateness and 12 percent were inappropriate,” said Dr. Paul Chan, MD, a researcher of Saint Luke’s Mid America Heart Institute.

They found that 98% of all inappropriate angioplasties involved patients who had no symptoms or only mild symptoms. Rates of inappropriate angioplasties also varied greatly between hospitals. Researchers expressed concern about potential overuse of the procedure and that some hospitals may be performing angioplasties for which the patient will receive no benefit.

The study entitled “Appropriateness of Percutaneous Coronary Intervention” appears in this month’s issue of The Journal of the American Medical Association (JAMA).

“At an average cost of $20,000 for each angioplasty procedure, this translates to $300 million annually—and this does not take into account the long-term costs of medication treatment and complications from treatment, such as bleeding,” Dr. Chan added. “In this health care climate of limited resources, the finding of inappropriate angioplasty in some hospitals suggests overuse of the procedure and an opportunity to improve decision making as to which patients should be selected for an invasive and costly procedure.”

Dr. William Boden, of Kaleida Health in Buffalo, NY, felt that the study’s numbers of inappropriate angioplasties was conservative. 12% is a “is a low estimate” he told Reuters by email, “because it uses a liberal (American College of Cardiology) definition of what was appropriate.”

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