Angioplasty costs are higher and outcome is poorer at non-surgery hospitals

Angioplasty is a common surgical procedure to clear blocked coronary arteries. This procedure is performed at facilities ranging from tertiary medical centers, which provide the highest level of care, down to non-surgery hospitals, which are not equipped for emergency heart surgery. According to a new study, costs are lower and outcome is better at angioplasty that is performed at full-service facilities. Researchers from Duke University Medical School in North Carolina presented their findings on November 4 at the American Heart Association scientific meeting, which runs from November 3 through November 7 at the Los Angeles Convention Center.

The researchers note that elective (non-emergency) angioplasty is becoming increasingly common at hospitals that do not conduct more complicated heart procedures. The procedure involves inserting a balloon-tipped catheter into an artery, which is inflated to open the narrowed coronary artery. The investigators reviewed billing data from more than 18,000 patients and found that the average cumulative medical costs were $23,991 in surgery-equipped hospitals, compared to $25,460 in those without surgical centers. “Surprisingly, there was no difference in procedure cost,” noted Dr. Eric Eisenstein, lead author of the study and assistant professor of medicine at Duke. He added, “We did find a difference in follow-up cost.”

The difference was primarily due to the fact that non-surgery hospitals used intensive care units (ICUs) for post-angioplasty care, as required by the study, and patients treated at these hospitals were more likely to be readmitted nine months after treatment. “Rising costs of medical care make it very pertinent for us to assess value,” noted Dr. Mark Hlatky, director of the cardiovascular outcomes research center at Stanford University. Dr. Eisenstein explained, “There is no guarantee that a community hospital can provide angioplasty services at costs comparable with those of major hospitals with on-site cardiac surgery.”

According to the American Heart Association, more than 1 million coronary artery opening procedures are performed in the US each year. The physician makes a small incision near the groin and then inserts a catheter (flexible tube) through the incision into the femoral artery. Sometimes the catheter is inserted in an arm or wrist. The patient is awake during the procedure. Live X-ray images will be used to carefully guide the catheter up into the heart and coronary arteries. Dye is then injected to highlight blood flow through the arteries. This helps the doctors visualize any blockages in the blood vessels that lead to the heart.

A guide wire is moved into and across the blockage. A balloon catheter is pushed over the guide wire and into the blockage. The balloon on the end is blown up (inflated). This opens the blocked vessel and restores proper blood flow to the heart. A stent (wire mesh tube) may then be placed in this blocked area. The stent is inserted along with the balloon catheter. It expands when the balloon is inflated. The stent is then left there to help keep the artery open.

Arteries can become narrowed or blocked by deposits called plaque. Plaque is made up of fat and cholesterol that builds up on the inside of the artery walls. This condition is called atherosclerosis. Not every blockage can be treated with angioplasty. Some need coronary bypass (heart surgery).

Angioplasty may be used to treat:

·         Persistent chest pain (angina) that medicines do not control

·         Blockage of one or more coronary arteries that puts you at risk for a heart attack

·         Blockage in a coronary artery during or after a heart attack

Risks
Angioplasty is generally safe, but ask your doctor about the possible complications. Risks of angioplasty and stent placement are:

  Allergic reaction to the x-ray dye

  Bleeding or clotting in the area where the catheter was inserted

  Damage to a heart valve or blood vessel

  Heart attack

  Kidney failure (higher risk in people who already have kidney problems)

  Irregular heart beats (arrhythmias)

  Stroke (this is rare)

  Allergic reaction to the stent material

  Allergic reaction to the drug used in a drug-eluting stent

  Blood clot

  Clogging of the inside of the stent (in-stent restenosis) 

                      

Reference: American Heart Association scientific meeting

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