Patients Underestimate Risks and Overestimate Benefits Of Elective Angioplasty, a Yale Study Finds

Patients about to undergo their first elective angioplasty to clear a coronary artery tended to minimize the risks and overestimate the benefits, a study by Yale researchers has found.

“I don’t know what happened when they discussed the procedure with their doctors, but almost half of the patients could only name one potential risk from the procedure,” said Eric Holmboe, M.D., assistant professor in internal medicine at Yale School of Medicine and principal investigator of the study. “And when asked why they were having the procedure, a number of them simply said: ‘I have a blockage and I need to open it.’”

An angioplasty is a surgical technique in which a balloon is inflated inside a blood vessel to flatten any plaque that obstructs blood flow. Although the procedure can be used to clear arteries, veins or capillaries, it is most commonly used to open coronary arteries. After the artery is opened by the balloon, a device called a coronary stent is put in to help keep the artery open.

An angioplasty can relieve chest pain, but there is no definite evidence to date that it will lower the risk of a future heart attack.

“The only clearly proven benefit of an angioplasty is relief of chest pain or other symptoms,” Holmboe said. “There is no strong data showing lower risk of heart attack and lower risk of dying. The majority of these lesions have slowly progressed over time, which has allowed other collateral arteries to help feed that tissue that is at risk. These patients don’t tend to get what we call ‘the big one.’”

The risks of an angioplasty include, to varying degrees, inducing a heart attack or stroke during the procedure, hemorrhaging, infection and death.

Holmboe and his colleagues interviewed 52 patients, 39 to 87 years old, on the eve of their surgery. The results were published in the Journal of Internal Medicine.

Seventy five percent of the patients believed the procedure would prevent a future heart attack and 71 percent thought the angioplasty would prolong their lives. When asked about risks, only 46 percent of the patients could recall a single risk factor. Yet the majority of patients felt the decision whether or not to have the surgery should be up to them alone, or made in partnership with their physicians.

Holmboe said it was clear that many patients did not have a clear understanding about the risks or benefits of the procedure. “It is possible that patients didn’t want to think about the possible risks, but a number of patients specifically told me they could not recall a discussion about risk with their physicians,” he said.

Holmboe said the study adds to the body of literature that suggests that patients are either not hearing or not getting the information they need to make a more informed decision about an angioplasty when the surgery is elective.

The other Yale researchers involved in the study were David Fiellin, M.D., assistant professor of medicine; Elizabeth Cusanelli, nurse practitioner, Yale-New Haven Hospital; Michael Remetz, M.D., associate professor, internal medicine, cardiology; and Harlan Krumholz, M.D., associate professor, internal medicine, cardiology.