With 700,000 procedures in the U.S. annually — at an estimated cost of $14 billion — appropriate use of coronary stents has become one of the hottest issues in cardiology. Eight studies have found stents are no better than drug-based therapy in preventing heart attacks and death in patients with stable heart disease.
Next year, the main U.S. heart-doctor group will remove the word it has used since 2009 to describe cases where people don’t need the metal-mesh tubes in their blood vessels. The label has become a liability in treatment disputes with insurers and regulators, said Robert Hendel, who led the effort that updated the wording.
“The term ‘inappropriate’ caused such a visceral response,” said Hendel, a cardiologist at the University of Miami. “A lot of regulators and payers were saying, ‘If it’s inappropriate, why should we pay for it, and why should it be done at all?’”
The cardiology group replaced the “Inappropriate” label with “Rarely Appropriate.” Another category — cases in which there’s medical doubt — will switch from “Uncertain” to “May be Appropriate.”
The changes reflect the controversy that has enveloped coronary stents, which are threaded through the circulatory system on catheters to prop open blocked arteries. With 700,000 procedures in the U.S. annually — at an estimated cost of $14 billion — appropriate use of the devices has become one of the hottest issues in cardiology. Eight studies have found stents are no better than drug-based therapy in preventing heart attacks and death in patients with stable heart disease.
As many as 12 percent of such elective stent cases were “inappropriate” under the ACC’s guidelines, according to a 2011 study in the Journal of the American Medical Association, while 38 percent were “uncertain,” leaving about half that were “appropriate.”
Unnecessary stents cost the U.S. health care system $2.4 billion a year, said Sanjay Kaul, a cardiologist and researcher at Cedars-Sinai Medical Center in Los Angeles.
Founded in 1949, the ACC is the nation’s main professional group of cardiologists, representing about 37,000 members. Its panels issue guidelines on the best treatment options for cardiovascular diseases. Though doctors aren’t bound by the recommendations, insurers, state medical boards and civil courts pay close attention to them when controversies arise.