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Is your doctor prescribing ‘low-value’ heart care?
If your doctor orders a medical test for you, how often do you question it?
If it’s a test or procedure related to your cardiovascular health, chances are you just go ahead and take their recommendation. We’re all anxious to protect our heart health, so why wouldn’t we listen to our doctor?
Well, a recent in-depth review of research by the American Heart Association may cause you to shift your thinking a bit.
The Scientific Statement, published last month, is an expert analysis of current research, along with proposed solutions to reduce “low-value” cardiovascular care.
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What is “low-value” health care?
“Low-value” heart care? Who would want that?
“Low-value” health care refers to any medical test, treatment or procedure that does more harm than good.
This could mean that the potential health benefits, such as symptom relief, are outweighed by the potential harm, including potential risks and complications, and the cost to the patient.
And when it comes to cardiovascular care — there appears to be a high frequency of low-value tests and procedures. Nearly 50 percent of patients in the U.S. will receive at least one low-value test or procedure per year
AHA calls out low-value cardiovascular care
The American Heart Association has just published a scientific statement that offers expert analysis of the current research on the use of low-value health care in cardiovascular health.
Dr. Vinay Kini is an assistant professor of medicine at Weill Cornell Medical College in New York. He also chaired the group that wrote the scientific statement.
“Cardiovascular disease is common and can present suddenly, such as a heart attack or abnormal heart rhythm. Our desire to be vigilant about treating and preventing cardiovascular disease may sometimes lead to use of tests and procedures where the benefits to patients may be uncertain. This may impose burdens on patients, in the form of increased risk of physical harm from the low-value procedure or potential complications, as well as follow-up care and out-of-pocket financial costs.”
In other words, because we are so afraid of heart disease and its complications, like heart attacks, doctors tend to insist on tests and medical procedures that may or may not be necessary, and that impose unnecessary risk on the patient, medically or otherwise.
Tests like echocardiograms and stress tests are readily available, another reason that they tend to be “over-prescribed.”
The AHA’s statement reports that up to one in five echocardiograms and up to half of all stress tests performed in the United States would be rated as “rarely appropriate,” based on guidelines set out by the American College of Physicians, the American College of Cardiology Foundation, and other medical groups.
For example, a patient who has had a stent or bypass surgery gets a yearly stress test, even if they feel well and have no symptoms. The stress test may lead to more invasive tests that come with higher risks, higher costs, and greater mental and emotional stress.
They also added that some of the devices that monitor heart rate and physical activity also evaluate heart rhythms, yet more than one-third of these recordings may be subject to misinterpretation by clinicians and patients.
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How do we start fixing the problem?
The AHA Statement offers several options for reducing low-value cardiovascular care.
For patients. Become educated about the test or procedure you’re being offered. Don’t be afraid to ask questions. Make sure you understand your doctor’s purpose and hoped-for outcomes when prescribing a test or procedure.
For doctors. The statement speaks of a “layered” approach to reducing low-value health care: education, feedback from patients and audits of how many low-value procedures and tests they prescribe, and tools built into the system that remind them to consider other options.
Remember, this isn’t the first time we’ve heard that some treatments are not necessary, are recommended way too often, or are downright dangerous.
Just a couple of years ago, cardiologist Dr. Elizabeth Klodas shared the results of a major study on the effectiveness of stents and bypass surgery.
That research revealed the best way to treat stable coronary artery disease is to address the root cause of it. In the case of artery blockages, that means adherence to a healthy lifestyle and taking medications as indicated. In fact, the benefits of many low-value treatments and procedures are available through such “alternative forms” of care, including nutrition.
The researchers found that invasive procedures — stents and bypass surgery — were no more effective in terms of influencing outcomes. In fact, the only upside of invasive procedures seemed to be that, in some cases, they lessened chest pain.
All the more reason to consider the risks involved in any procedure.
Editor’s note: There are perfectly safe and natural ways to decrease your risk of blood clots including the 25-cent vitamin, the nutrient that acts as a natural blood thinner and the powerful herb that helps clear plaque. To discover these and other secrets of long-lived hearts, click here for Hushed Up Natural Heart Cures and Common Misconceptions of Popular Heart Treatments!
Sources:
Do you really need that test? New statement highlights need to reduce “low-value” heart care — Eureka Alert 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease — Circulation
By Joyce Hollman
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