Strategies to Avoid 5 Highly Overused Treatments

Leigh Page

July 16, 2013

In This Article

Heart Vessel Stents

Percutaneous coronary interventions (PCIs) involve placement of stents in patients' heart vessels through angioplasty. The summit identified overuse in elective PCIs but not in emergency PCIs, where stents save the lives of patients.

Robert O. Bonow, MD, professor of cardiology at Northwestern University Feinberg School of Medicine in Chicago, said there may still be some overuse of PCIs, either for reimbursement reasons or because of "knee-jerk reactions" from cardiologists who have not updated their practice.

Dr. Jessup, the AHA president, said that when PCIs were introduced more than 20 years ago, they underwent a familiar cycle for breakthrough technology. "There was a huge embrace of it at first, and then a settling down of utilization, more to where it should be," she said.

Although a few cardiologists have pushed stents to the point of being criminally prosecuted, patients may also push for stents, she said. "Patients will say, how come I'm not getting a stent?" she said. "There needs to be more education of physicians, and patients, too," she said.

Recommendations: Encourage standardized reporting in the catheterization and interventional procedures report, encourage standardized analysis/interpretation of noninvasive testing for ischemia, focus on informed consent and promote patient knowledge/understanding of the benefits/risks of PCI, and provide public and professional education.

Proceedings from the National Summit on Overuse. Released July 8, 2013. Full text

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