For heart patients trying to choose between medication, angioplasty or surgery, it may be best to follow their doctor's advice, suggests a Brazilian study.
The study included 611 patients with severe coronary artery disease affecting at least two blood vessels but not yet causing a loss of heart function. The patients met with their individual cardiologists for evaluation. After examining a patient, each cardiologist conferred with another cardiologist, and then recommended one of three treatments for the patient.
The three options were: medication; noninvasive angioplasty using balloons and/or stents to open clogged arteries; or coronary artery bypass graft (CABG) to reroute blood through new vessels grafted into place.
A year later, patients who received their doctor-recommended treatment had a much lower incidence of problems, while patients who received a different treatment than that recommended by their doctor had an increase in negative events, the study found.
Physician judgements important
Among the second group of patients, the most common and only statistically significant issue was the need for additional treatment for blocked arteries. There were no statistically significant differences in heart attack or death rates between the two groups of patients.
"Our data is a reminder that physician judgment remains an important predictor of outcomes," study co-author Dr Alexandre C. Pereira, a cardiologist at the University of Sao Paulo Heart Institute, said in a prepared statement.
"We should always remember that the therapeutic decision option is the final result of a complicated equation that uses both objective and subjective variables, which will not necessarily be acquired by lab tests, imaging exams or objective questions in a clinical questionnaire," Pereira said.
"In this scenario, physician judgment - with all of the subjectivity that it may imply - still appears to be the best test or exam that a patient may have," Pereira noted. The findings were published in the current issue of the Journal of the American College of Cardiology. -(HealthDayNews, August 2006)
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