HEART DISEASE TREATMENT

     A study funded by the National Heart, Lung and Blood Institute, suggests that certain patients treated with bypass surgery tend to live longer than those treated with angioplasty plus stents.  The study followed 190,000 people 65 and older with heart disease in at least two of their coronary arteries.  After one year, there was no statistically significant difference between the two groups.  But after that, bypass patients had the advantage.  By the four year mark, they had a 21 percent lower mortality rate than those who had angioplasty,

    “It is essential to get the first treatment right,” says David M. Shahian, M.D., a professor of surgery at Harvard Medical School.  “It can affect your life for years to come.”  Many patients can opt for just diet, exercise and drugs.  For others, surgery to bypass the narrowed arteries provides a survival advantage, according to a study in the April 19, 2012 new England Journal of Medicine.  One of the largest problems is that ‘the interventional cardiologist acts as the gatekeeper,” says William Boden, M.D, chief of medicine at the Samuel A. Stratton VA Medical Center in Albany, N.Y.  But that specialist only represents his or her skill set.”

    Dr. Boden points out that with cancer treatment in which specialists confer to provide optimum care, the complexity of heart disease requires a range of expertise.  In 2011 that heart team was endorsed by several organizations representing different cardiovascular specialties.  When there is no single “right” treatment that is the best one.  Your primary care doctor will help coordinate care.  A non invasive cardiologist may perform initial tests and manage medical treatment.  The interventional cardiologist could perform the diagnosis angiogram as well as the angioplasty.  Cardiothoracic surgeons could discuss the surgery option to build the heart team.  In nonemergency situations the group should confer after the angiogram and then discuss options with the patient.  “In the ‘real world’,” says Brahmajee Nallamothu, M.D., an associate professor at the University of Michigan Cardiovascular Center in Ann Arbor, “Systems are not set up to encourage it.”