Readers needed a thoughtful look at what at first glance appeared to be a massive amount of evidence supporting a more invasive approach to heart treatment. This story carefully put the findings in perspective. Unlike competing coverage, the story did not encourage readers to opt for surgery but more likely will result in more patients having frank conversations with their physicians before deciding on a treatment plan.
Patients with coronary artery disease are faced with important treatment decisions. Whether to rely on medical treatment, coronary artery bypass surgery or coronary angioplasty requires some detailed information about the pluses and minuses of each approach for a given patient. The study was observational and while a number of statistical methods were employed to deal with differences in the two groups, the results should be viewed as suggestive and not confirmatory.
Like its counterparts, this story fails to say a word about costs of the two procedures. Based on our calculations, the two procedures have about a $44,000 price difference and with a Number Needed to Treat of 23, the costs of avoiding a death in this patient population at 4 years exceeds $1 Million. We think that is an important health policy consideration.
The story did a reasonable job in describing the benefits and placing them in context with comments about potential harms
Unlike the AP and the NPR story we reviewed, this story at least provides a bit of information on the early trade off between angioplasty/stent and bypass surgery. “Researchers found that at one year after the procedures, death rates were about the same for surgery and stents, reflecting the higher risk of mortality from the open-heart procedure itself—about 2% for surgery compared with about 1% for stenting. The short-term risk of surgery can affect patients’ treatment decision, especially given the prospect of open-heart surgery and weeks of recovery, compared with a less-invasive angioplasty.”
This is one of the few stories that covered the topic to actually explain why this type of study can’t say definitively which treatment option is better. “The gold standard for testing medical treatments is the randomized trial, in which patients are randomly assigned to a treatment or control group to spread patient differences evenly and avoid bias in results,” the story says. “Registry studies such as the current one enable researchers to use accumulated data on the real-world experience of thousands of patients, but as the current study suggests, that doesn’t necessarily resolve uncertainty over which treatment approach is better.’
It also provides some important caveats about the study limitations
The story says, for example, “The study didn’t include data on whether a patient is healthy or frail, or what a patient’s preference was, researchers said. It is possible, for instance, that patients were referred to stent use because they were too sick to withstand surgery, and that could be an important reason for the higher death rate among those patients.”
There is no disease mongering in the story, and it makes it clear what type of patient was being studied: “The patients studied had heart disease in two or three of the vessels that provide blood to the heart. They were stable, and thus didn’t need a procedure urgently. Currently, such patients could be candidates for either approach.”
The story sought out a variety of views and, even in quoting the lead researcher, emphasized how nobody “would say the results will completely change the way we do things.”
The comments of the experts are balanced and provide the reader with some semblance of the difficulties that are inherent in this type of decision making.
The study itself was about comparing two treatments, and this story was superior to the NPR story and the Associated Press story we reviewed in making those comparisons clear.
Still, we would have liked to have seen some comments on the third alternative available to people with coronary artery disease, medical treatment. Without some mention, people with coronary artery disease may be led to believe that there are only interventional options. For many this is not the case.
Although the story did not explicitly note the general availability of bypass surgery and angioplasty/stent, there are sufficient hints to allow the reader to appreciate that they are routinely offered.
Adequate: “The latest research, which is generally consistent with other recent studies that give an advantage to bypass surgery”…”He cautioned that all of the studies—including the new one—have limitations”
The story does not rely on 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
Comments (1)
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Aggie
April 2, 2012 at 11:57 amToo bad they did not include patients treated with drug therapy. Did the story mention the other risks of bypass surgery, such as depression? Just wondering…
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