The controversy over the appropriate use of cardiac stents received more attention in late September, when Bloomberg News reported that half of all cardiac stent procedures in the United States are unnecessary. Stents represent big business in the United States. Approximately 700,000 stent procedures are performed each year to the tune of more than $110 billion. According to the Bloomberg report by, nearly half of these procedures are unnecessary.
We’re not sure if the 50% number is too high or too low, and we don’t want to get into a debate about the numbers. Nevertheless, overuse of cardiac stents is old news to us. Hayes has reviewed the entire body of evidence that exists for this procedure, and it’s clear that stenting should only be performed in certain patients. Why, then, are we seeing so many unnecessary stenting procedures? Even the experts are concerned. In a paper released in July 2013, the Joint Commission and the American Medical Association-Convened Physician Consortium for Performance Improvement (PCPI) identified elective stenting as one overused treatment that provides “zero or negligible benefit to patients, potentially exposing them to the risk of harm.”
Would you want to undergo a procedure that yields zero or negligible benefit and potentially exposes you to harm? Unfortunately, in a healthcare system where physicians are financially rewarded according to the number of procedures they perform—whether patients need them or not—it becomes quite easy to implant a stent in a low-risk patient who won’t benefit, or who could be injured or die as a result of the procedure. And that’s what’s happening in real life.
There’s no argument that in the right patients stents are appropriate, and guidelines exist to identify suitable at-risk patients. In a 2012 report coauthored by the American College of Cardiology Foundation, the American Heart Association, the Society of Thoracic Surgeons and three other specialty societies, experts advised that procedures to restore blood flow to the heart (such as stenting) were best reserved for patients with major symptoms of poor heart health and/or insufficient blood flow to the heart. In contrast, revascularization procedures for patients without symptoms or patients with low-risk findings who need minimal medical therapy were viewed less favorably.
Stents are just one more example of how providers continue to miss opportunities to practice evidence-based medicine and drive down costs, not to mention the real and potential harm to which patients are exposed when we overutilize or underutilize health technologies. Isn’t it about time we stopped giving lip service to evidence and really started using it to give patients the patient-centered care they deserve?