This broadcast nicely reassures viewers that millions of Americans with stable, non-emergency coronary artery disease can manage their heart problems well with medicine and do not need to undergo surgery to implant stents that prop open clogged arteries. It clearly differentiates between patients with “unstable” disease who might benefit from stenting and those in the current study with “stable situations” who have a lower risk of heart attacks and death—an important distinction for viewers to understand. The broadcast notes that about a million people receive coronary stents each year, and that, at $15,000 to $25,000 apiece, fewer procedures would save the healthcare system substantial amounts of money. Though the broadcast neglects to note some useful information—about the potential harms of drug therapy and stents, as well as about other therapies that might help patients with stable disease (including lifestyle interventions such as smoking cessation, changes in diet, and exercise)—the take-home message remains appropriate and clear: “When it comes to getting a stent, most patients don’t need to rush,” according to ABC News correspondent John McKenzie. Readers should note that the new trial was published online in the New England Journal of Medicine to coincide with its presentation at the annual meeting of the American College of Cardiology, a detail omitted in the broadcast.
Overall, this was a good job, especially within the often self-imposed limitations of TV news.
The broadcast explains that the cost of implanting a stent runs between “15 to 25 thousand bucks,” and suggests that the procedure is not cost-effective in about half of those currently considered candidates.
The broadcast summarizes the trial’s results in general terms but does not report the actual number or percentage of heart attacks and deaths (the trial’s primary outcome). Over the course of follow-up, there were 211 deaths and nonfatal heart attacks in the group receiving stents plus optimal medical therapy, and 202 such events among patients receiving optimal medical therapy alone. After 4.6 years, the cumulative event rates in the two groups were 19% and 18.5%, respectively—nonsignificant differences.
The broadcast does not mention potential harms of medical therapy or stenting. This information was also omitted from the trial’s published manuscript. What should a patient know about complications and other side effects associated with these treatments? A sentence summarizing harms reported in previous studies would have been helpful.
The broadcast describes a large, randomized, controlled trial in which one group of more than a thousand patients received medical therapy and another group of equal size received medical therapy plus stents. The story does not mention that the new study was published in the New England Journal of Medicine simultaneous with its presentation at the annual meeting of the American College of Cardiology. Nor does it mention previous smaller studies that reached much the same conclusion.
The story is careful to distinguish between coronary artery disease that is characterized by unstable, potentially dangerous angina and “stable situations” that are less likely to result in heart attacks and death. Rather than stirring up fear about disease, the broadcast is appropriately reassuring, pointing out that millions of people with stable angina can be safely treated with medication alone and do not require stents.
The broadcast includes interviews with two experts, though it fails to provide details about their potential conflicts of interest, including the fact that Dr. Boden was the principal investigator of the trial under discussion.
The broadcast explains that the newer, higher-tech, more expensive, and more invasive therapy (stenting) is no better than the standard alternative–medical care with drugs. It neglects to note that a range of other therapies may also be appropriate for the non-emergency heart patients described in the broadcast, including angioplasty (without stents) and lifestyle interventions such as smoking cessation, changes in diet, and exercise. Indeed, all of the patients in both wings of the new study received advice on lifestyle interventions, though this was not noted in the broadcast.
The broadcast states that about a million people receive coronary stents each year, and suggests that stents are not only widely available but also overused.
The broadcast explains that stenting has become a mainstream therapy for millions of Americans.
No obvious use of text from a press 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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