Heart patients who live in areas where doctors perform lots of invasive heart procedures are no better off than those where high-tech care is used more sparingly, new research suggests.
Dr. Edward Guadagnoli of Harvard Medical School, lead author of one of the studies in the New England Journal of Medicine, looked at the experiences of 3,689 elderly heart attack victims who were treated at hospitals in New York and Texas in 1990. Forty-five percent of the patients got angiograms in Texas, compared to 30% in New York. The test, which involves injecting dye into the heart arteries and taking X-ray movies, is performed on more than 1 million Americans annually.
Over the next two years, the patients were slightly less likely to die in New York than in Texas. Furthermore, the Texas patients were more apt to report angina chest pain and trouble performing daily activities.
In the other study, of 21,772 heart attack patients, Dr. Louise Pilote and others from the Cleveland Clinic Foundation in Ohio found that patients in New England were significantly less likely than those elsewhere to receive angiograms as well as coronary bypass operations and angioplasties, which are used to clear blocked heart arteries.
Nonetheless, the New England patients were no more likely than others to suffer new heart attacks or die.