Doctors' Judgment Validated in Treating Heart Disease

Better outcomes seen when individual treatments are concordant with doctors' recommendations

TUESDAY, Aug. 29 (HealthDay News) -- Doctors really do know best when it comes to prescribing the most beneficial treatments for patients with coronary artery disease, according to research published online Aug. 29 by the Journal of the American College of Cardiology.

Alexandre C. Pereira, M.D., of the University of Sao Paolo Medical School in Brazil, and colleagues studied 611 patients with multi-vessel coronary artery disease. After two cardiologists saw each patient and recommended medication, angioplasty or coronary artery bypass surgery, the patients were randomly assigned to one of the three treatments.

After a year, the researchers found that 40 (6.5 percent) patients had refractory angina requiring revascularization, 45 (7.4 percent) had myocardial infarction, and 28 (4.6 percent) died. Even after adjustment for other variables, they found that clinical judgment was a powerful predictor of outcomes, with the best results seen in patients whose treatments were concordant with their physicians' recommendations and the worst results seen in patients who received percutaneous coronary intervention in discordance with their physicians' recommendations.

"As we continue to embrace evidence-based medicine as well as evaluate randomized clinical trials, the important lessons from this report should also be kept in mind," states Ori Ben-Yehuda, M.D., in an accompanying editorial. "It is indeed reassuring that there is still a role for the art of medicine."

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