Deaths following a common procedure to unblock heart arteries are still more common at smaller hospitals than at hospitals where the procedure is routine, but the gap has narrowed considerably, according to a new study.
Heart experts currently recommend that patients have nonemergency angioplasty -- a procedure in which a balloon-tipped catheter is threaded into a blocked artery and inflated, flattening fatty plaques against the artery wall -- in hospitals where more than 200 of the procedures are performed each year. While the study's author told Reuters Health that she is not calling for changing these guidelines just yet, she said more research should be conducted into angioplasties performed at smaller hospitals, which are the closest medical centers for many people.
"We may be eliminating access to a lifesaving procedure," said Dr. Vivian Ho, from Washington University in St. Louis.
Ho's study included more than 350,000 patients who underwent angioplasty in California from 1984 to 1996. From 1984 to 1987, 2.5% of people who underwent the procedure in hospitals where it was performed less than 200 times a year died while still hospitalized, compared with only 1.3% of those treated at hospitals that performed more than 400 angioplasties a year. During the period from 1993 to 1996, the death rate at high-volume hospitals remained steady, but it declined to 1.7% in low-volume hospitals.
Even though medical centers that perform angioplasty routinely still have better records, their advantage is much smaller than it was when angioplasty was introduced in the 1980s, according to Ho. The researcher suggests that lower standards may be appropriate in less populated areas where there may not be a major medical center.
"We're facing a trade-off in terms of access," Ho told Reuters Health. "We need to actually take a closer look at why these smaller hospitals have improved over time," she said. Perhaps many of the physicians who perform angioplasties at smaller centers trained at high-volume hospitals, according to Ho. Other factors, such as improvements in technology and medication may also have helped close the gap, she said. Once these factors are better understood, it may make sense to reconsider the minimum volume standards, she said.
But according to Dr. Thomas J. Ryan, of Boston University Medical Center, who chaired the guidelines committee, the gap between high- and low-volume centers remains significant. In fact, recent research suggests that the standards might need to be raised, he noted in a statement.
"It appears that the recommendation for elective angioplasty will continue to emphasize procedural volume minimums at the 400 to 600 procedures per year level," he said.
