Survey finds you may not have been told about other options.
When fatty plaques threaten to obstruct the coronary arteries, three treatment options are available: medications to control symptoms; a procedure to open the blockages with a balloon (angioplasty), usually followed by the placement of a stent, a cylindrical metal scaffold that holds the vessel open; or surgery to bypass the blockages (coronary artery bypass grafting, or CABG). Each treatment has benefits and risks, and may be more appropriate for some individuals than for others.
But if you and your doctor make the decision to undergo elective angioplasty and stenting, there’s a good chance you will not be told about the other treatment options. A national survey of Medicare beneficiaries conducted by leading medical centers, including Harvard-affiliated Massachusetts General Hospital, found that only 10% of people who underwent stenting were given other options to consider, and only 16% were asked about their treatment preferences. Although 77% discussed the reasons for angioplasty with their doctors, only 19% were told about the potential drawbacks of the procedure.
Why this is worrisome
In last month’s Heart Letter, we discussed the factors that go into a doctor’s decision to recommend angioplasty or CABG when the situation is not an emergency. But sometimes a decision must be made between angioplasty and medical management—that is, drug therapy. Both approaches can relieve chest pain (angina). But in this case, angioplasty is not more likely than medical management to prevent you from dying from your heart disease.
Making an informed decision
If there’s a chance you someday might be told that you need an invasive procedure to improve blood flow to your heart. If it’s not an emergency, take time to think through your decision. Ask your cardiologist the following questions:
What are the potential benefits of this procedure, and why are you recommending it for me?
What are the potential risks?
Are there good alternatives?
How do their risks compare?
How do the benefits of these alternatives compare with the procedure you recommend?
If there is time, you may want to discuss the recommendation with your primary care physician, who may be able to provide an unbiased opinion.
Above all, don’t let anyone pressure you into making a decision that you don’t understand or agree with. You have the right to full disclosure of all treatment options and their risks, benefits, consequences, and uncertainties.