A Needed Change Of Heart

Alice Park spoke to David Jones about his new book, Broken Hearts: The Tangled History of Cardiac Care, and the reasons why bypass surgery and angioplasty aren’t all they’re cracked up to be:

Each intervention, promising lifesaving relief, was embraced with enthusiasm by cardiologists and cardiac surgeons—and both techniques often do provide rapid, dramatic reduction of the alarming pain associated with angina. Yet, as Jones painstakingly explains, it took years to show whether the procedures prolonged lives; in both cases, subsequent research deflated those early hopes. The interventions—major procedures, with potentially significant side effects—provided little or no improvement in survival rates over standard medical and lifestyle treatment except in the very sickest patients. …

“There’ve been focus groups with prospective patients who have stunningly exaggerated expectations of efficacy. Some believed that angioplasty would extend their life expectancy by 10 years! Angioplasty can save the lives of heart-attack patients. But for patients with stable coronary disease, who comprise a large share of angioplasty patients? It has not been shown to extend life expectancy by a day, let alone 10 years—and it’s done a million times a year in this country.”

Kevin Hartnett outlines the reasons we continue to use the procedures:

First, “one of the little dirty secrets of cardiac care” is that until the 1970s, “heart experts could not agree on what was causing heart attacks.” Today, cardiologists believe that “invisible lesions” in the heart vessels—not major artery blockages—are primarily responsible for causing heart attacks. So, in a sense, bypass and angioplasty were grandfathered in as treatments from an era when we didn’t really understand why heart attacks happen.

Second, the popularity of bypass surgery and angioplasty reflects a larger cultural issue with medicine: We overtest and overtreat. Doctors and patients tend to think, “Well, if this procedure could help, let’s do it.” But every surgery comes with risks, of infection, and, in the specific case of bypass surgery, of long-term neurological complications. “It’s important not to do everything that could be done,” Jones told Park.