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May 29, 2015

Few Patients Well-Informed When Considering Heart Procedure to Relieve Chest Pain

When patients are well-educated about the decision, fewer decide to undergo the procedure.

Percutaneous coronary intervention (PCI), also known as coronary angioplasty, is a non-surgical procedure used to open blocked arteries caused by heart disease. Each year, more than one million Americans undergo PCI, often to restore normal blood flow after a heart attack. However, some patients choose to undergo PCI to relieve symptoms associated with heart disease, such as chest pain and shortness of breath.

Experts worry that patients considering PCI to relieve chest pain may not be properly informed about the risks and benefits of the procedure. Although PCI helps relieve symptoms in patients with chronic chest pain (also called chronic angina), it doesn’t decrease risk of heart attack and death. Surveys show that patients somehow misinterpret information and believe that PCI reduces risk of such complications.

To see how well doctors educate patients about PCI, researchers recorded conversations between cardiologists and patients with chronic chest pain considering PCI. During these conversations, researchers were looking for seven key elements necessary for proper decision making. These elements include discussion of the clinical issue and the patient’s role in decision making, as well as possible treatment alternatives and the pros and cons associated with each option. Doctors are expected to review the uncertainties associated with the procedure, such as possible risks and benefits, and assess whether the patient understands the issues discussed together. Finally, doctors should explore patient preference, taking into account the patient’s thoughts and feelings.

According to the study published in JAMA Internal Medicine, after recording 59 conversations conducted by 23 cardiologists, researchers found that only 3% of conversations met the criteria above. Another 14% of conversations were somewhat acceptable but only met certain criteria for proper decision making. The more informed patients were about their decision to undergo PCI, the less likely they were to choose the treatment. Researchers found that most patients decided against PCI because of the uncertainty of outcomes.

Authors believe that based on their findings, most conversations between cardiologists and patients considering PCI for chronic chest pain are incomplete. It’s of utmost importance that patients get all the facts before making decisions regarding their health. Although PCI is a relatively safe procedure, it is an invasive procedure with certain risks. Furthermore, it is not always 100% effective in relieving symptoms. Patients need as much information as possible to make a decision about treatment, and additional efforts are needed to improve these discussions and decisions.

Questions for You to Consider

  • Who is at risk for angina?
  • Those at greatest risk for angina include individuals with heart disease, diabetes, high blood pressure, high cholesterol, or a family history of heart disease. Excess stress, smoking, older age and a lack of exercise can also increase risk for angina. Fortunately, most of these risk factors can be reduced by working with your doctor and making positive lifestyle changes.
  • How is angina treated?

  • Angina can be treated in a variety of ways, including lifestyle changes, medications, and medical procedures. For example, quitting smoking, losing weight and reducing stress can help successfully treat angina in some patients. For others, medications like beta blockers or procedures such as angioplasty and stenting may be necessary to treat the condition.

Featured Video

Dr. Anne R. Albers, FACC, presents at a Living with Chronic Angina event in Columbus, Ohio in Oct. 2014.

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