This piece asked more tough questions than the story in the LA Times. It also provided readers with more of the hard data than the other story. It broke down a complicated topic and allowed readers to view the evidence from multiple vantage points. Ultimately, though, like the Times piece, it did not take the extra step of giving readers and health policymakers the information they need to assess whether this industry-funded study is an important discovery. Will this truly save millions of lives? Or is it a baby step that is, as this story mentions, more of a “boost for the heart-rhythm device business, whose sales have flattened in recent years”? Those questions are raised but not adequately addressed.
Defibrillators are a significant investment, and their success as a clinical intervention depends in part on whether their widespread use will be funded. Both stories discuss the broad scope of the problem — 22 million people with heart failure worldwide — and they raise the issue of the devices’ costs. Stories like this also need to provide readers the context of how much additional benefit individuals and society as a whole would reap from increased use of these expensive devices. Reporters should always be skeptical when a tried and true device for an acutely ill population is repackaged for a broader group of patients.
This story was more precise on costs than the LA Times, saying, “The devices cost up to $35,000, versus the roughly $25,000 cost of a standard defibrillator. Hospital and doctor fees can raise the total cost over $50,000.” Both stories said, vaguely, that “the cost” of the disease every year is $40 billion. This is confusing to readers for two reasons. One, there is no single payer shelling out $40 billion every year to treat heart failure, and so that number is likely not much more than a very good guess. Two, it leads people to believe that the device, at $50,000 per person, may be a bargain if heart failure right now costs $40 billion to treat. We applaud the Journal for at least raising this issue high in the story. The story cites Eric J. Topol, cardiologist and chief academic officer at Scripps Health, saying, the reduced rate of hospitalizations in the study “may actually present a net reduction in costs from a societal standpoint.” That’s a big what if.
As explained above, the story analyzes the benefits in both relative and absolute terms.
The story says, “But the study showed an increase in the number of device- or implantation-related complications within 30 days of implant: 118 among 888 patients with the new device, compared to 61 of 898 in the standard defibrillator group.” This is beyond what the LA Times did, and we think it is adequate for this score.
The story, in most ways, does a better job than the LA Times in evaluating the quality of the evidence. It mainly accomplishes this by providing more data. For example, it says, “Overall in this study, mild-to-moderate-symptom patients had a 25% relative reduction in death or heart-failure hospitalization with the pacemaker-defibrillators, compared with a standard defibrillator. (This was also a 7.1 percentage point “absolute” reduction in death and hospitalization—33.2% compared with 40.3%.)” By giving readers both the relative reduction and the absolute reduction, the story provides a more complete picture of the findings. The one missing element was something we almost never see in a story that the LA Times provided, which is the number needed to treat (NNT). The Times story says “Fourteen patients had to be treated with the $35,000 device to prevent one death.” Perhaps this is a smart investment. Providing that NNT figure, though, gives people the right perspective on the findings.
The story does not engage in disease-mongering. It did make it sound like heart failure exacerbations happen rapidly, with minor changes in diet. This is not supported by the science. But this is a minor quibble.
The story does a good job quoting outside sources, but we wish it had done a better job identifying how many of these folks have conflicts.
The story did not adequately explain the comparison between the device and alternatives. For example, research has shown that patients with mild heart-failure can undergo training to take better care of themselves and reduce their number of hospitalizations, too.
The story makes it clear that the device studied is in clinical trials for the targeted patient population and that a similar device is on the market. “Just over a month ago, Boston Scientific won federal approval to treat mild-symptom heart-failure patients with such devices. Medtronic is seeking such approval, but already sells it for more severe heart failure patients.” We would have liked to have seen some estimate of how many people have these devices implanted every year.
The story makes it clear that there are multiple companies pursing a similar device and that one is already on the market.
The story does not rely on a news release.