for me it is so true.

What’s a heart patient to do? There seems to be no easy answer to the question of whether it’s better to have your arteries propped open with a bare metal stent or a higher-tech, drug-eluting one… or none at all. The former carries a risk that the blockage will recur… the latter brings an increased risk of blood clots… and there are some cases in which stent placement actually worsens outcomes, though clearly doing nothing at all can be dangerous as well. The answers to these complex questions are continually revised as medical research keeps evolving. I wrote about it here in Daily Health News two years ago, in fact. Stents themselves represented a real breakthrough in cardiovascular medicine — they’re faster and less invasive than bypass surgery at opening a blocked artery when a person is having or is at severe risk for a heart attack. However, attempts to refine the technology have failed to produce a clear-cut advantage either way.

So I turned to Harlan M. Krumholz, MD, professor of cardiology, epidemiology and public health at the Yale University School of Medicine and director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation, for an update on the latest thinking for people with heart disease. According to Dr. Krumholz, both types of stents are viable options, since doctors have learned how to minimize the risks associated with drug-eluting ones — and he agreed that there is always some risk involved with any intervention. The best answer ultimately depends on the priorities and risk profile for each patient.

IS IT STILL A CONTROVERSY?

Though it stirred up the cardiology world at the time, Dr. Krumholz told me that the controversy about the propensity of patients to develop blood clots after insertion of drug-eluting stents has calmed down, since patients who get this higher-tech medical device are now routinely prescribed anti-clotting medications. Proper therapy mitigates the risk, Dr. Krumholz said. Discuss the particulars of your situation with your doctor.

When it comes to cost, however, the questions sort out differently. The costs associated with drug-eluting stents are significantly higher than bare metal stents, which means patients (and doctors) are often faced with trying to decide the most cost-effective form of treatment. Those individuals at lower risk for re-narrowing of the blood vessels may do better with the bare metal stent, while others who have difficulty taking the medication and/or are unlikely to take it for the necessary 12 months may need to weigh that as a factor. These issues can only be resolved by asking the right questions and getting honest answers.

A SOFTWARE SOLUTION?

One hospital group in the Midwest has found a solution. Dr. Krumholz told me about a new and innovative Web-based program now in use at the Saint Luke’s Mid America Heart Institute in Kansas City, Missouri. It is software designed to be used as part of the decision making process. Cardiac patients and medical staff work through the program together — it creates a customized risk assessment for each type of stent with clear explanation of the risks that accompany each. Called PREDICT and initially designed as a way to improve the informed consent process, the program personalizes the risks in a way that makes it very easy to understand. A study of the system, published in the September 2008 issue of Circulation: Cardiovascular Quality and Outcomes, a journal of the American Heart Association, focused on how helpful patients found these individualized risk-assessment/consent forms. Researchers reported that patients who used the PREDICT system understood their risks better, had better recall of the details of the procedure and less anxiety about the treatment process.

Such tools may well represent a new direction for helping to make medical decisions that match patients with the procedure most likely to be successful in their particular case.

Source(s):

Harlan M. Krumholz, MD, professor of medicine and epidemiology and public health (cardiology), Yale University School of Medicine, New Haven, Connecticut.

John Spertus, MD, professor, University of Missouri — Kansas City, director of Health Outcomes, Mid America Heart Institute of Saint Luke’s Health System, Kansas City.

The banter attached to today’s blog entry of empathy and compassion perhaps show the large populace of the United States is egocentric, self absorbed, and suffers from self esteem issues.

George’s fucked up statement is par for his course and is nothing new and we all know about his issues and intelligence factor. We have come to expect that from him. I think you will find his bottle of meds on the third shelf down on the left side, right behind the untouched shaving cream…

Where the fuck are your meds? If I could I would help you find them and shove the and the bottle up your ass.

Gloria