- Associated Press - Wednesday, August 8, 2012

CHICAGO (AP) - In an Aug. 7 story about concerns about the overtreatment of patient chest pain, The Associated Press erroneously reported the number of angioplasties performed annually in the U.S. The procedure is done about 700,000 times each year, not about 7 million times.

A corrected version of the story is below:

HCA probe shines light on chest pain overtreatment

Overtreating chest pain is in the spotlight as investigators probe procedures at HCA hospitals

An investigation into one of the nation’s biggest hospital chains is refocusing attention on concerns about overtreatment for chest pain.

Many doctors are unclogging arteries to treat the pain, providing quick relief. However, studies have shown medicine is a safer and cheaper alternative for patients whose heart disease isn’t life-threatening.

That research has changed thinking about the wisdom of routinely doing the artery-opening procedures called angioplasties. But experts say money and uncertainty over individual patients’ risks are among reasons doctors have been slower to change their ways.

The Nashville-based hospital chain, HCA Holdings Inc., said on Monday that investigators want information about heart procedures performed at some of its 163 hospitals. A New York Times story suggests some patients got needless angioplasties and stents.

About 700,000 angioplasties are done each year, and almost half of them are elective, performed on patients with stable chest pain. Evidence suggests the numbers haven’t dropped dramatically since a landmark 2007 study said drug treatment worked just as well at preventing heart attacks and related deaths.

An angioplasty can cost $20,000 and usually involves inserting a small mesh stent to keep arteries propped open. Often an overnight hospital stay is needed. Drug treatment may take a few months to relieve pain and often requires several medicines, including aspirin and statins, but most have generic versions costing hundreds of dollars a year, not thousands.

Patients often want the quicker fix, and Yale University cardiologist Harlan Krumholz says many patients mistakenly think elective angioplasties will do a better job of keeping them alive.

Doctors may disagree with the studies and recommend angioplasties, but they are obliged “to explain to patients that their opinion is at odds with what the evidence is,” Krumholz said Tuesday.

According to the New York Times, citing internal HCA documents, some of the hospital chain’s patients got invasive treatment even though they had no significant heart disease.

Nationwide data suggest that about 8 percent of non-emergency angioplasties are done inappropriately, on patients who should be getting drug treatment alone instead, said Dr. William Weintraub, cardiology chief at Christiana Care Health System in Newark, Del.

Needless stenting was among procedures to be avoided on a checklist released earlier this year by nine medical societies concerned about overtreatment.

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