Strong point: use of the number needed to treat or NNT.
Weaker point: seemed to be more boosterish, less balanced than competing Wall Street Journal story.
Because defibrillators are a significant investment, 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. This story provided the crucial “number needed to treat” calculation, giving readers a good metric for how to weigh the device’s benefits, but it also fell short in other areas.
The story provides this great detail when discussing costs: “Fourteen patients had to be treated with the $35,000 device to prevent one death.” More context around costs and a better explanation of the $40 billion price tag attached to heart failure would have been welcome.
By using the NNT, as mentioned above, and providing some other figures, the story did an adequate job quantifying the benefits.
The story says that “Complications were about twice as common with the combination device, primarily because connecting the leads to the ventricles takes longer and requires a higher skill level. The extra leads also increase the possibility of infections.” We would have liked to have seen the actual numbers, which were provided in the Wall Street Journal piece. We also think that, instead of attributing the reason for the complications, as the Journal did, to the study’s lead author, the story gives unqualified legitimacy to the basis for the harms. Without any hard numbers and without the proper sourcing, we think the handling of harms here falls short.
The story did not evaluate the quality of the evidence as thoroughly as the Wall Street Journal. The WSJ, for example, gave readers both the relative reduction and the absolute reduction in deaths. This story did provide one improvement over the Journal story, something we rarely see: the number needed to treat (NNT). The story says “Fourteen patients had to be treated with the $35,000 device to prevent one death.” Unfortunately, the story also included a lot of unchallenged statements, saying that the study “gives us reason for renewed enthusiasm about heart failure treatment” and that it “supports the idea that doing this works.” Maybe. Readers of the Journal article may have a different takeaway.
In the Wall Street Journal story, the lead says that the device “can significantly improve the chance for survival among the tens of thousands of heart-failure patients with only mild symptoms.” That’s a reasonable and cautious statement. The LA Times story, by contrast, goes a little over the top, to our minds, saying, “The report is the second one indicating that such combination devices, which are about the size of a cellphone, can save the lives of many of the 6 million Americans with heart failure, and many surgeons are already using them for that purpose. About 70% of heart failure patients have the milder form of the disease for which the new study was conducted. The condition requires frequent hospitalizations and costs the U.S. healthcare system an estimated $40 billion per year, according to the American Heart Assn.” By frontloading the story with that framing, the story is selling this device to the readers as a way to save millions of lives, instead of carefully walking readers through the evidence, as the Journal does.
The story does quote outside sources, but we wish that the story had taken the same care in bringing in some outside perspective on the cost-benefit question as the Wall Stteet Journal did. Both stories contained elements of boosterism, but this story did not have the balance that the Journal story did.
The story did not adequately explain this approach as compared to other approaches to reduce adverse effects in people with mild heart failure, the population of interest. One would read this story and leave with the mistaken impression that literally millions of Americans have just one choice: get this expensive surgery or risk dying.
The story explains that the device studied is in clinical trials for the targeted patient population and that a similar device is on the market. ” Last year, U.S. researchers reported that a combination device manufactured by Boston Scientific reduced the death rate by 29% for patients with moderate heart failure in a study of about 1,800 patients. In September, the Food and Drug Administration gave the company approval to market the device for this indication.” We would have liked to have seen some estimate of how many people have these devices implanted every year.
The story did not rely on a news release.