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Aggressive Treatment Best for Some Heart Problems

Invasive approach costly but worth it

TUESDAY, Oct. 15, 2002 (HealthDayNews) -- Aggressive medical treatment for certain heart conditions costs more than a conservative approach, but tackling the problem early is worth the extra money, a new study finds.

Researchers from Atlanta's Emory University School of Medicine looked at the six-month costs and the long-term effectiveness of both approaches for patients with two heart conditions -- unstable angina (chest pains) and a specific kind of heart attack, called a non ST-segment elevation myocardial infarction. Both conditions account for about 1.4 million U.S. hospital admissions annually.

The researchers drew from a study published last year, in which other investigators compared the health effects of the two approaches on 2,220 patients and found the aggressive early treatment strategy was superior.

In the new study, the researchers took a closer look at 1,722 of the original 2,220 patients, says Elizabeth Mahoney, a biostatistics expert at Emory and lead author of the study, which appears in tomorrow's Journal of the American Medical Association.

"We collected economic information from all these patients," Mahoney says. "We had them report emergency room visits, outpatient visits and procedures. We collected information about indirect costs, lost productivity." The goal, she adds, was to determine whether the early, aggressive treatment also made sense from an economic point of view.

Patients in the early invasive strategy group were catheterized within four to 48 hours after being assigned to the group and then received such techniques as balloon angioplasty (in which a balloon is inflated to open up the vessel) as needed. The conservative group received catheterization only if blood flow decreased greatly to the heart or a stress test was positive.

The bottom line?

"The initial hospital costs were indeed higher for the patients having the invasive strategy -- higher by about $1,700," Mahoney says. "But by the end of the six-month period, the patients in the conservative strategy group had significantly higher follow-up costs because they ended up going into the hospital more often."

At the end of six months, the difference between the two groups shrunk from $1,700 to $600, but the costs were still higher for the invasive group.

Then the researchers looked at health results. "The invasive group had far fewer nonfatal heart attacks during the six months," Mahoney says.

Using population-based studies that look at life expectancy with and without a fatal heart attack, the researchers then concluded that "the benefits are worth the investment" in terms of amount of life gained, Mahoney says.

The invasive approach translates, for some of the patients, to an additional one to two years of life at an overall cost of $8,000 to $15,000 per year of "extra" life. Those figures are within bounds considered acceptable in the U.S. health-care system.

"The results reinforce the results from the clinical report for broader use of the early invasive strategies," Mahoney says.

After the clinical study was published last year, the recommendation to treat the conditions with early invasive strategy was incorporated into the practice guidelines of the American College of Cardiology and the American Heart Association.

The new study "provides very important complementary information to the clinical data that have already been reported," says Dr. David Cohen, associate director of interventional cardiology at the Harvard Clinical Research Institute and Beth Israel Deaconess Medical Center, He wrote an editorial to accompany the study.

"Most cardiologists have suspected this for some time, and this study is the first to corroborate this impression," Cohen adds.

Mahoney's study was funded by Merck & Co., the pharmaceutical giant, and Cohen notes he has received funding from manufacturers of interventional cardiology devices.

What To Do

For more information on heart attacks, the American Heart Association offers this guide to the warning signs. And the National Institutes of Health has a fact sheet on angina.

SOURCES: Elizabeth Mahoney, Sc.D., biostatistics expert, Emory University School of Medicine, Atlanta; David Cohen, M.D., M.Sc., associate director, interventional cardiology, Harvard Clinical Research Institute and Beth Israel Deaconess Medical Center, Boston; Oct. 16, 2002, Journal of the American Medical Association
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