How Much is Your Life Worth?
Reported October 3, 2006
By Caroline Penn, Ivanhoe Health Correspondent
(Ivanhoe Newswire) — You could add months, even years to your life by choosing the right heart surgery. So how do you decide? It depends on how much you are willing to spend.
Up to 40 percent of heart patients with severe coronary disease are being treated with medications or angioplasty when a bypass is what would really prolong their life, according to a long-term study from Duke University in Durham, N.C. Bypass has not been the first choice because it’s more invasive and expensive. However, studies are showing that patients who opt for the more expensive bypass are living longer than those who receive the more affordable angioplasty.
Peter K. Smith, M.D., principal investigator for this study and chief of cardiothoracic surgery at Duke University Medical Center told Ivahoe, “It may seem counterintuitive to start a patient on the most invasive treatment option, but our analysis showed that [bypass] surgery provided a significant improvement in longevity for patients with severe disease.”
Angioplasty involves inserting an expandable device — a balloon or a stent — into a blocked coronary artery through a tube and then expanding it. This opens the artery by pushing blockage against its walls. Bypass surgery involves opening the chest and surgically bypassing any blockages with healthy arteries taken from other parts of the body, like the leg.
Researchers analyzed the post-surgery health of 18,481 patients from 1986 to 2001 who had at least one coronary artery that was more than 75-percent blocked and who had received either bypass surgery, angioplasty, or heart medications. This study closed before the use of drug-eluting stents came into use.
Bypass surgery and angioplasty stenting provided more benefit for patients then medicines alone. Patients who received bypass surgery lived an average of 5.3 months longer than those treated by angioplasty. For patients with the most severe disease, procedures added 23.6 months of life over medication alone. Dr. Smith believes more patients should be having bypass surgery recommended by their doctors.
“Stenting is less expensive than surgery, initially. But people have had to have multiple re-interventions. Repeat interventions wind up costing about the same amount as the coronary bypass procedure within five years. How do you attach a price tag on longevity? That’s pretty difficult,” Dr. Smith told Ivanhoe.
SOURCE: Ivanhoe interview with Peter K. Smith, M.D., chief of cardiothoracic surgery at Duke University Medical Center and Annals of Thoracic Surgery, 2006;82:1420-1429