Panel Issues New Criteria For Treatment Of Heart Blockage
January 05 2009 - 2:15PM
Dow Jones News
DOW JONES NEWSWIRES
Several major medical associations that deal with heart disease
Monday issued new criteria for treating patients with clogged
arteries and said artery-opening procedures weren't necessary for
patients with milder symptoms who weren't treated with drugs.
The panel weighed when it was appropriate to pursue procedures
such as bypass surgery or the opening of arteries with catheters,
which often involves leaving a tiny stent behind. Such procedures
are appropriate, the panel determined, when patients have severe
symptoms and are already taking the best-available medication.
The results appear to be in line with a major study called
"Courage" that two years ago signaled it was safe to try
drug-treatment alone in stable patients before adding
artery-opening angioplasty.
That study had a major negative impact on sales of heart stents,
where Boston Scientific Corp. (BSX), Abbott Laboratories (ABT),
Johnson & Johnson (JNJ) and Medtronic Inc. (MDT) are the major
producers.
Gregory J. Dehmer, a representative of a 17-member panel that
drew up the criteria of the more recent study, said the findings
could improve practices of physicians who find only 60% or 70% of
their procedures are appropriate. In developing the criteria, the
group studied about 180 clinical scenarios.
"The whole purpose of this document is to get the right
treatment for the right patients at the right time, not viewed as
increasing or decreasing the number of bypasses done or the number
of stent procedures done," said Dehmer, who also is a professor of
medicine at Texas A&M University College of Medicine, as well
as cardiology, and director at Scott & White Clinic.
Specifically, the panel said it wouldn't be appropriate to send
patients for artery-opening procedures if plaque buildup was in
just one or two arteries, or if the patient had symptoms only
during heavy exercise, had a small amount of heart muscle at risk
and wasn't taking medication to help control symptoms.
Dehmer, an interventional cardiologist who implants stents, said
at a time when the cost of medical care is a huge concern in the
U.S., a goal was to offer patients a more cost-effective approach
to medical therapy and to offer physicians a benchmark so they can
recalibrate what they are doing in terms of offering the most
appropriate treatment.
The panel said it hopes health insurance providers will use the
criteria in developing payment and pre-authorization policies.
The criteria, put together by the American College of
Cardiology, American Heart Association and other big medical
organizations, are designed to address patients who may not have
been included in clinical trials.
Also involved in formulating the new criteria were the Society
for Cardiovascular Angiography and Interventions, Society of
Thoracic Surgeons, American Association for Thoracic Surgery and
American Society of Nuclear Cardiology. The criteria have been
endorsed by the American Society of Echocardiography, Heart Failure
Society of America and Society of Cardiovascular Computed
Tomography.
-By John Kell, Dow Jones Newswires; 201-938-5285;
john.kell@dowjones.com
(Jon Kamp contributed to this report.)
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