"The Risks of Heart Stents"
Millions of people have gotten stents for stable
coronary artery disease; yet, we now know that for such patients,
angioplasty and stent placement doesn’t actually
prevent heart attacks, doesn’t even offer
long-term angina pain relief, and doesn’t improve survival.
Why? Because the most dangerous plaques—
the ones most vulnerable to rupture leading to a heart attack—
are not the ones doctors put stents in, not the ones
often even seen on angiogram to be obstructing blood flow.
So “[w]e need to avoid the ’therapeutic illusion‘ that we are
accomplishing more than is shown by the evidence.”
It looks great. You’re opening up blood flow.
But if it doesn’t actually help, why do it?
And we’re not just talking about billions of dollars wasted.
Stent placement and the blood-thinner drugs
you have to go on can cause complications,
including heart failure, stroke, and death.
The risks are relatively low; less than a 1% chance
it will kill you or stroke you out.
The 15% risk of heart attack is only if your stent clogs off
at a later date, which only happens in about 1% in the near-term.
The 13% kidney injury is legit, though, due to the dyes
they have to inject, but that typically just heals on its own.
The most serious complications, like death,
only happen in about 1 in 150 cases.
But you have to multiply that by the fact that hundreds
of thousands of procedures are being done every year.
In an emergency setting, like while you’re actively having
a heart attack, angioplasty can be lifesaving, but these
hundreds of thousands are for stable coronary artery disease,
for which there appears to be no benefits.
So then, doctors are killing or stroking out
thousands of people a year for nothing.
And that’s not even counting the tens of thousands
of silent mini-strokes that may contribute
to cognitive decline caused by these procedures.
Between 11 and 17% of people who go through angioplasty
or stenting come away with new brain lesions.
That’s like up to one in six.
How do doctors convince patients to sign up for these
when they don’t lower the risk of death, or heart attack,
or offer long-term symptom relief?
Apparently by conveniently failing to inform patients
that they don’t lower the risk of death or heart attack,
or offer long-term symptom relief.
Cardiologists are aware of how little they help,
but studies have consistently demonstrated that patients think
stents will reduce their risk of heart attack or death.
More than 70% of patients erroneously believed that stents would
extend their life expectancy or prevent future heart attacks.
That’s why this study was done—to figure out where
patients are getting these crazy ideas from.
And the answer is that many patients are being kept
in the dark, pressured into procedures that won’t benefit them
the way they think, by doctors that overstate
the benefits and understate the risks.
Why would they do that?
Well, one reason could be because doctors
may be paid per procedure. Doctors are paid more
for offering stents than common sense diet and lifestyle changes.
Patients with stable coronary disease undergoing angioplasty
and stent placement are frequently misinformed.
Of 59 recorded conversations, only two included
all seven elements of informed decision making—
in other words, telling people they have a choice,
explaining the problem, discussing alternatives,
the pros and cons, informing patients the procedure
may not work, asking if they understand, even just asking
if patients have any questions,
and asking patients what they want to do.
Only 3% of doctor-patient discussions about stents
hit even just these basic elements.
And that’s when the doctors knew they were being recorded;
so, if anything, this may be like the best-case scenario.
Three percent!
Quoting from the Journal of the Cleveland Clinic,
when it comes to angioplasty and stents,
“[t]rue informed consent rarely occurs.”
No wonder that among the nearly 1,000 patients surveyed
across 10 U.S. academic and community hospitals,
just 1% knew the truth.
Remarkably, some blame the patients for their ignorance,
they’re the ones that “overestimate [and] misunderstand the benefits ...
such as patients with cancer who believe [their chemo]
offers the potential for cure—
they have a ‘therapeutic misconception.’”
Don’t look at the patients to find out why so many patients
are accepting procedures with questionable benefits.
“Patients think they are having life-saving procedures because
medical professionals want them to believe that this is so.”
Now, it’s not like those 95% of cardiologists are lying
to their patients and saying that it will reduce their risk.
They just happened to conveniently have omitted that little detail.
But in the absence of information to the contrary,
most patients are going to naturally assume that’s the case.
Why would they just assume that?
Because patients have this crazy concept of “personal care”—
that a physician’s ﬁrst obligation is solely
to the patient’s well-being.
How naïve can you get?
In the absence of information,
or even when presented with evidence to the contrary,
patients tend to believe that treatments offered will be beneficial.
It’s true, even if you explicitly tell patients that stents
don't reduce the risk of heart attacks.
Yes, you can cut that misperception in half.
That’s great that with two sentences
you can dispel the myth in most people.
But many participants continued to believe
that angioplasty and stents prevent heart attacks,
even when explicitly told they do not,
along with a detailed explanation why.
After all, why would doctors be pushing them if they didn’t help?
That’s a good question, which we’ll address next.