This HealthDay story reports on a paper published in the European Heart Journal that looked at the outcomes of a procedure known as catheter ablation for people who have atrial fibrillation.
We liked how the story countered the positive findings with the caveats and complications, which are too often overlooked in news stories about research.
However, the story didn’t clearly explain that this was not a randomized controlled trial–it was essentially a tallying of complication and success rates in a group of people who all had the procedure done. And that’s an important distinction to make, because as one cardiac electrophysiologist columnist pointed out and this systematic review touches upon, there’s a lack of solid trial data on this procedure.
Because this is a very common condition, it will be of high interest to many readers. They deserve to know: What makes this research newsworthy? Is the research solid? Will it change what’s already known about catheter ablation?
The story does mention the procedure is often covered by insurance. But it didn’t discuss the costs without insurance (or to the health care system). Estimates put it at roughly $10,000 for the procedure, and quite a bit more once hospital costs are factored in.
This story does provide a numerical picture of the data analysis. It states: “Ablation was successful in 74 percent of patients, Arbelo said. These patients had no atrial arrhythmias–irregular heart beats–for three to 12 months after the procedure.” This means that nearly three out of four patients benefited in some way by having the surgery, although it was not a permanent solution.
However, the story didn’t mention that the success rate fell to 66% when you considered the entire 12 month period, including the first 3 months.
The story points out the caveats that should be remembered when considering ablation. It explains some of the complications that can occur, and that the procedure may only be a short-term fix.
However, there was definitely a missed opportunity to dig more deeply, and report the scope of the harms as clearly as the benefits. For example, the story didn’t explain 1 out of 10 people had to go back for a repeat procedure during the study. Nor that there were 280 in-hospital complications (7.8%) and 577 complications over the 12 month follow-up (16.3%). Some of the complications were quite serious, including 47 perforations of the surrounding heart tissue.
The story points out that nearly 3,600 patients, aged on average 59 years old, from Europe, the Middle East and North Africa took part in the study. But, it fails to identify that this is actually an observational registry, essentially a description of complication and success rates, rater than a double-blind randomized trial that was evaluating a therapy vs. placebo. This means there were lots of limitations to this research, and those weren’t discussed in the story. Without these details, the story makes the research sound much more conclusive than it really was.
This was a tough call. The story does some things well here: It gives us the prevalence of atrial fibrillation, and explains that this procedure is for people who don’t experience improvement with medications.
But it could have gone a step further, and explained that most people with atrial fibrillation have no symptoms, or the symptoms are well controlled with medication–so catheter ablations are really only considered for a minority of this patient population.
Since it does make that distinction to a degree (that the procedure is reserved for people who can’t control symptoms via medication) we’re rating it satisfactory.
The story does quote two cardiologists unconnected to the study, but fails to disclose possible conflicts of interest among the researchers. For example, the lead researcher has accepted money from Biosense Webster, a company that makes medical products for atrial fibrillation treatments.
The story explains that medication is the first-line treatment: “For those whose atrial fibrillation can’t be controlled with medications, catheter ablation may be recommended.”
We do wish the story had made it clear that few people with atrial fibrillation fall into the group needing ablation.
Catheter ablation is available in most medical centers offering broad cardiac services, but the story didn’t explain that.
The story indicates that the study is new, but it didn’t explain what made it novel–how does this build upon previous research? It implies that it’s the less-than-impressive success rate vs complication rate, but that needs better clarification, if that’s what’s novel here.
Because there is commentary from independent researchers, the story does not appear to rely on the news 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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