The story reports on new research that shows angioplasty performed late after a heart attack (defined as 3 to 28 days) does not improve survival, chance of another heart attack, or chance of heart failure compared to taking medications alone in a subset of people. The story does a nice job of describing the current culture surrounding late angioplasty, that is, it is currently routinely done but that this new research questions that practice. This is the first randomized controlled trial of this clinical situation (as opposed to observational studies) and the results are surprising, which is described by the article. The article also describes the benefit and harm (the trend toward an increase in risk for heart attack with angioplasty) in absolute terms, which is refreshing. A criterion that was not met was the inclusion of cost information. While the article states angioplasty is expensive, it's not clear what the costs are or that medications are less expensive over a lifetime. Cost information could have made this a stronger story, but overall, the article does a nice job of meeting the vast majority of criteria.
The article doesn't mention costs of angioplasty or costs of medications, which presumably must be taken for the rest of one's life. The article does mention that angioplasty is expensive, but does not provide real numbers or comparisons.
The story provides absolute numbers of the primary endpoint over a 4-year period — "17 percent of those given angioplasty and drugs and nearly 16 percent of those given drugs alone had either died, suffered another heart attack or developed heart failure — results considered to be statistically the same."
The story states that there was a worrisome trend toward more heart attacks in people who received late angioplasty compared to those who received just medications, although the story also tells readers that this could have been a statistical fluke or due to chance. However, other harms of the procedure were not discussed, including risks of the procedure itself, including bleeding, infection, or emotional distress/anxiety. The article also does not discuss risks of the alternative, e.g. medications, which have side effects, costs, or inconvenience. But, the story does discuss the main harm found in the study, e.g. a trend toward increased heart attacks.
The research is important because it is a randomized controlled trial and the first such trial to be conducted for the clinical situation of late angioplasty in people with few to no symptoms after their heart attack. The story tells readers that enrollment of patients was delayed because "doctors were unwilling to risk randomly assigning patients to drug treatment alone," indirectly stating that the study was a randomized trial. While an astute reader could probably pick up that this was a randomized trial, this fact could have been clearer. In addition, there is little context around this being the first randomized trial for this clinical situation (as opposed to retrospective observational studies), although the story does tell readers that the results were surprising and that they could change guidelines.
The story appropriately describes a heart attack, and more importantly, reinforces that early opening of the artery to restore blood flow to the heart after heart attack is still beneficial and that these results don't apply to that population or indeed the majority of people receiving angioplasties. No obvious disease mongering.
The article provides an independent source of information from the chairman of the American Heart Association program committee that reviewed the research. The story also provides information from the director of the National, Heart, Lung, and Blood Institute, but tells readers that this organization largely funded the research, therefore disclosing potential conflicts of interest.
The story tells readers that the alternative that was tested in the latest research was medications, including those to lower blood pressure and cholesterol, aspirin, and anti-clotting drugs. The story could have mentioned beta-blockers specifically, since the protective effect of drug treatment may come from this family of drugs, although this is not yet proven. And the story could have been clearer about the course of treatment, e.g. that these medications are generally taken for the rest of one's life.
The story tells readers that the usual treatment for people suffering a heart attack is angioplasty, even for a subset of people who weren't treated right away (the study population)/ The article also tells readers that the tendency to perform angioplasty electively (3 to 28 days after the event) was so strong, that recruitment to the study was prolonged in order to find enough patients (and their doctors) willing to participate in the study.
It's widely understood that angioplasty and standard drug therapy after heart attack are not new.
The article provides independent sources of information not included in the press release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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