The story provides a lot of good information and gathered a variety of views from doctors. But the story only hinted at harms and costs, without quantifying these. We’re not sure that readers got a clear, overall assessment of what to do with this evidence.
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.
This story, the NPR story and the Wall Street Journal story we reviewed all failed to mention costs.
The cost of the two approaches (CABG vs coronary angioplasty with stent) are dramatically different as is the time for recuperation and rehabilitation. The NNT (CABG vs angioplasty/stent) is about 23 (20.8-16.4=absolute risk reduction of 4.4%). Based on the Healthcare Blue Book the difference in cost is in the neighborhood of $44,000. ($68,000 for CABG; $24,000 for angioplasty/stent) Then it would cost about $1 Million per life saved at four years.
In the lead, the story qualifies the research findings by saying that patients “may have a little lower death risk over time”. The story goes on to quantify the benefits of the different approaches, but it does so in relative terms only, never providing people with the actual number of patients who had positive or negative outcomes. It says, “Death rates were similar one year after either treatment. But after four years, nearly 21 percent of the angioplasty patients had died versus about 16 percent of those who had bypass surgery.”
In a story about whether to choose a more invasive surgery, explaining harms to readers is especially important. A competing Wall Street Journal did a much better job on this front.
We would have liked to have seen a bit more information about the limitations to this type of study and the conclusions drawn. The story did provide important caveats; “It’s not the kind of study that gives conclusive evidence, but doctors say it gives a “real world” look at how people fare in ordinary practice,” and “The new study “nudges you a little closer” to favoring bypass, but because of the caveats, “in the end, it says it is a close call.” We think that the story squeaks by with a satisfactory score here however.
No disease mongering here.
To its credit, there are a lot of voices in this short story, and we applaud the attempt to capture so many views. We think readers will be confused, ultimately, though. It ends with doctor affiliated with the American Heart Association saying, “We still think a traditional operation is excellent” for people with multiple blockages. Is he talking about an angioplasty and a stent? Or is he agreeing with most of the views in the article which seem to indicate that more people should be opting for bypass surgery?
The study itself was a comparison of two procedures, and the story does a decent job reflecting the study’s findings.
The story could have included a comment about medical management even though it is beyond the scope of the study under consideration.
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.
The study is not unique except for the size of the sample. The story does provide a bit of context (“…largest of ever of this issue”)
The story clearly does not rely on a press release.