One in eight U.S. patients who have non-emergency stenting procedures to clear blocked arteries in the heart are likely to see more harm than good from the procedure, researchers said Tuesday.
The findings stoke concern about overuse of the invasive treatment, which costs the nation some $12 billion a year and offers few benefits over drug therapy unless the patient has suffered a heart attack.
"More than half of the inappropriate cases were in patients who didn't have any symptoms at all," said Dr. Paul Chan, whose results appear in the Journal of the American Medical Association.
"If they are not benefiting, that's a problem," Chan, a cardiologist at Saint Luke's Health System in Kansas City, Missouri, told Reuters Health.
Each year in the U.S., about 600,000 stents -- small metal mesh tubes -- are inserted into ailing hearts to prop open blocked arteries, according to the new report.
While they are live-saving for patients with heart attacks and for some patients with severe chest pain even at rest, stents are no better than drugs at preventing new heart attacks or death in patients with stable heart disease.
Apart from a hefty price tag of about $20,000, the stenting procedure carries risks of complications like major bleeding or tears. And after leaving the hospital, people need to take clot-buster medications, which also increase the chance of bleeding.
Chan and his colleagues used data from more than 1,000 hospitals across the country. They checked that data against guidelines developed by several medical groups in 2009 to judge whether the hospitals' stent use was appropriate or not -- that is, whether the benefits were likely to outweigh the harms.
Of about half a million stenting procedures, about 71 percent were done during emergencies such as heart attacks.
Nearly 99 percent of those were deemed appropriate, although the researchers had to exclude more than 100,000 cases that didn't include sufficient information.
"In the acute setting, we are doing a very good job," Chan told Reuters Health.
But when patients had stents inserted for less-pressing reasons, the picture was not as pretty.
Almost 55,000 of those procedures, or 38 percent, were of uncertain benefit and 16,838, or 12 percent, were inappropriate. That's consistent with earlier research suggesting doctors in the U.S. are quicker than others to use stents in patients with stable heart disease.
In just over half of the inappropriate cases, the patients didn't have any symptoms of heart disease at all, and Chan speculated that a doctor might have sent them to get a stent based on screening results.
That makes little sense, however, because the only proven benefit of stents over drugs in stable heart disease is pain relief.
The researchers also found a lot of variation between hospitals. In one quarter of them, less than six percent of stenting cases were inappropriate, whereas in another quarter of the hospitals, more than 16 percent of stenting procedures were unwarranted.
"This represents an opportunity for those hospital to look at how they perform" stenting, said Dr. William B. Borden, of the Weill Cornell Medical Center in New York, who was not involved in the new work.
However, he said, not all of the cases deemed inappropriate will necessarily do more harm than good. It's possible, for instance, that a patient might have had a lot of pain even with all the guideline-recommended drugs -- beta-blockers and calcium-channel blockers, among others -- and would have been a candidate for stenting.
But another expert, Dr. William Boden of Kaleida Health in Buffalo, New York, said the number of inappropriate cases might actually be an underestimate.
Twelve percent "is a low estimate," he told Reuters Health by email, "because it uses a liberal (American College of Cardiology) definition of what is 'appropriate.'"
Copyright 2011 Thomson Reuters. Click for Restrictions.
Our 2024 Coverage Needs You
It's Another Trump-Biden Showdown — And We Need Your Help
The Future Of Democracy Is At Stake
Our 2024 Coverage Needs You
Your Loyalty Means The World To Us
As Americans head to the polls in 2024, the very future of our country is at stake. At HuffPost, we believe that a free press is critical to creating well-informed voters. That's why our journalism is free for everyone, even though other newsrooms retreat behind expensive paywalls.
Our journalists will continue to cover the twists and turns during this historic presidential election. With your help, we'll bring you hard-hitting investigations, well-researched analysis and timely takes you can't find elsewhere. Reporting in this current political climate is a responsibility we do not take lightly, and we thank you for your support.
Contribute as little as $2 to keep our news free for all.
Can't afford to donate? Support HuffPost by creating a free account and log in while you read.
The 2024 election is heating up, and women's rights, health care, voting rights, and the very future of democracy are all at stake. Donald Trump will face Joe Biden in the most consequential vote of our time. And HuffPost will be there, covering every twist and turn. America's future hangs in the balance. Would you consider contributing to support our journalism and keep it free for all during this critical season?
HuffPost believes news should be accessible to everyone, regardless of their ability to pay for it. We rely on readers like you to help fund our work. Any contribution you can make — even as little as $2 — goes directly toward supporting the impactful journalism that we will continue to produce this year. Thank you for being part of our story.
Can't afford to donate? Support HuffPost by creating a free account and log in while you read.
It's official: Donald Trump will face Joe Biden this fall in the presidential election. As we face the most consequential presidential election of our time, HuffPost is committed to bringing you up-to-date, accurate news about the 2024 race. While other outlets have retreated behind paywalls, you can trust our news will stay free.
But we can't do it without your help. Reader funding is one of the key ways we support our newsroom. Would you consider making a donation to help fund our news during this critical time? Your contributions are vital to supporting a free press.
Contribute as little as $2 to keep our journalism free and accessible to all.
Can't afford to donate? Support HuffPost by creating a free account and log in while you read.
As Americans head to the polls in 2024, the very future of our country is at stake. At HuffPost, we believe that a free press is critical to creating well-informed voters. That's why our journalism is free for everyone, even though other newsrooms retreat behind expensive paywalls.
Our journalists will continue to cover the twists and turns during this historic presidential election. With your help, we'll bring you hard-hitting investigations, well-researched analysis and timely takes you can't find elsewhere. Reporting in this current political climate is a responsibility we do not take lightly, and we thank you for your support.
Contribute as little as $2 to keep our news free for all.
Can't afford to donate? Support HuffPost by creating a free account and log in while you read.
Dear HuffPost Reader
Thank you for your past contribution to HuffPost. We are sincerely grateful for readers like you who help us ensure that we can keep our journalism free for everyone.
The stakes are high this year, and our 2024 coverage could use continued support. Would you consider becoming a regular HuffPost contributor?
Dear HuffPost Reader
Thank you for your past contribution to HuffPost. We are sincerely grateful for readers like you who help us ensure that we can keep our journalism free for everyone.
The stakes are high this year, and our 2024 coverage could use continued support. If circumstances have changed since you last contributed, we hope you'll consider contributing to HuffPost once more.
Support HuffPostAlready contributed? Log in to hide these messages.