Patients may expect too much of heart procedures

NEW YORK (Reuters Health) - Some heart disease patients may have overly optimistic expectations of procedures used to unclog coronary arteries, new research suggests.

In a study of 633 patients considering heart bypass surgery or angioplasty, researchers found that the patients typically expected the procedures to be more beneficial than their doctors did.

Among patients, 83 percent expected that their symptoms would improve, while the same percentage believed they would gain years in life. Their doctors, however, generally had lower expectations; they believed, for example, that 53 percent of the patients would live longer if they had angioplasty or bypass surgery.

Moreover, there was often a discrepancy between what the patients said their doctor told them about the procedures' benefits and what the doctor actually believed.

The researchers, led by Dr. Jeff Whittle of the VA Medical Center in Milwaukee, report their findings in the American Heart Journal.

Angioplasty and coronary bypass surgery are commonly performed in people with atherosclerosis, a hardening and narrowing of the arteries that impedes blood flow to the heart. In angioplasty, a balloon-tipped catheter is threaded into the diseased artery to push aside blockages and improve blood flow; in bypass surgery, a healthy blood vessel is sewn onto the diseased heart artery to reroute the blood around blockages.

Both procedures can ease heart disease symptoms such as chest pain and breathlessness, and may lower the risk of heart attack in some people.

The current study included patients at four U.S. hospitals who underwent angiography, an X-ray examination of the blood vessels to detect blockages. Overall, 633 patients were told they should consider either angioplasty or bypass surgery. Whittle's team interviewed these patients and the doctors who performed the angiography about their expectations of benefits.

Most patients and doctors did believe that the procedures would improve patients' symptoms, the researchers found. There was a greater divide when it came to expectations of improved survival. And the odds that any one patient's expectations would match up with his or her doctor's beliefs were no better than chance.

It's not clear why doctors' and patients' expectations conflicted in many cases, according to the researchers. But, they write, "the results suggest that physicians and patients are not communicating successfully about this key decision element."

They point out that, in "modern practice," patients who undergo angiography often make quick decisions about whether to have angioplasty or bypass surgery. This leaves little time for written materials, videos or other information that might help them better understand the benefits and risks of the procedures.

Future studies, Whittle and his colleagues conclude, "could confirm our findings, clarify factors that may lead to poor understanding of procedure benefits, and determine how patients' beliefs affect decisions."

SOURCE: American Heart Journal, October 2007.