This is an engaging and important enterprise story that explained a number of important issues to be factored in when considering medical interventions. It also nicely highlights the tension that exists in the development of new and presumably less invasive approaches to cardiac catheterization and angioplasty. It’s refreshing to still find 1,600-word stories that go into such detail.
It is clear from the story that:
However what was lacking from this story was an examination of the overall success rate of the intended procedure. While patient comfort surely has value, procedure outcome is vital. We never learned any data about whether the actual goal of opening an artery is any better one way or another.
Interestingly, the cited meta analysis is only partially acknowledged. While a trend was noted toward an advantage to the radial artery approach (in terms of bleeding and procedural outcome), the authors concluded a large randomized trial is necessary to determine the true value of the approach. And that wasn’t mentioned in the story.
Overall, though, the story delivers a clear picture of why patients need to have conversations with their caregivers about the risks and benefits of the various options available for their treatment. Being aware that there is often not a single answer to questions about the course of action is an important step towards making decisions that will get you the care that is best for you.
The online version also included helpful graphics and a video.
The story mentions that using the wrist may better enable patients to avoid an "expensive overnight hospital stay" and that Medicare reimbursement was the same even though this route for catheterization may involve more physician time. But the story didn’t include any specific cost information about this new approach. Shouldn’t the physicians interviewed know whether their charge to patients depends on the vessel used? Nonetheless, we’ll give the story the benefit of the doubt on this criterion.
The benefit of the treatment was presented in terms of patient comfort and time, and presented quantitative information indicating the radial approach results in a reduction in bleeding complications as compared with the femoral artery. But it did not provide any data about the outcomes of the procedure, namely, "How did it do in opening arteries?" It is interesting to note that the meta-analysis cited in the story concluded that additional studies are needed to better define the role of this approach, which was not mentioned in the story.
The story mentioned that arterial spasms tops the list of complications with this procedure and indicated that it was particularly problematic in "little old ladies." Beyond this, the story did not give the reader any idea of how common this sort of problem was, making it difficult for readers to evaluate.
The story did an incomplete job of including relevant evidence about the use of the radial artery for coronary catheterization. Since the cardiac cath and angioplasty is intended to relieve symptoms by unblocking a coronary artery, it would have been helpful to have commented on the literature on outcome differences between the two approaches. The story implies an equal outcome with less risk of bleeding and shorter hospitalizations; both positive from the patient’s perspective. Without any comment on the outcome of the cath and angioplasty, patients cannot place a value on the radial approach.
The story touched on the notion that there was a steep learning curve in order to develop proficiency using the radial insertion site. But there was both insufficient information for potential patients to use to assess whether the clinician they were consulting had adequate experience and what the ramifications of using this site without adequate experience might be.
The story did not engage in disease mongering.
The story included interview material from clinicians who utilize this technique only rarely as well as those who rely on it extensively. In addition, there were several patient quotes that presented the view from the other side of the table.
While there was no discussion about the appropriate use of cardiac catheterization in general, the story included information about the two arterial routes that may be used for the procedure.
The story indicated that radial catheterization is most likely not routinely available and that a low percentage (1%) of catheterizations are performed this way.
The story did a good job placing the novelty of the approach into context. Reading the various physicians’ experiences with this technique, it is clear that it is not novel and yet is also not commonly utilized.
Clearly, the story did not rely on a news release.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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