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#1
28.08.2007, 12:49
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"Неклинические" поводы для стентирования
Попалась такая вот статья, полный текст мне недоступен.
[Ссылки доступны только зарегистрированным пользователям ] Cardiologists cite nonclinical reasons for choosing PCI in stable CAD 16 August 2007 MedWire News: Nonclinical factors appear to influence whether cardiologists choose percutaneous coronary intervention (PCI) or medical therapy in stable coronary artery disease (CAD) patients, a study published in the Archives of Internal Medicine reveals. This may explain the widespread application of PCI in stable CAD for indications that are not supported by clinical evidence, say the study investigators, led by Rita Redberg (University of California, San Francisco, USA). Highlighting one example of this, Redberg told MedWire News: "Despite physicians saying that they knew the data showed no benefit of PCI over medical therapy for stable CAD for myocardial infarction reduction or mortality, they still felt and acted in a way that favored PCI to medical therapy, and that they 'knew' an open artery was better." Redberg's team looked at factors driving the decision between medical therapy and PCI in a qualitative study involving 20 cardiologists. Four to nine participants, including both non-interventional and interventional cardiologists, joined in three focus groups in which they discussed hypothetical case scenarios. The three scenarios each described a stable CAD patient with no symptoms or atypical symptoms and represented cases for which the available evidence suggests no benefit of PCI. Each patient had one or more significant coronary stenoses found at catheterization. The cardiologists generally believed that PCI would benefit the patients. Analyzing transcriptions of the audiotaped discussions, the researchers identified themes relating to physician factors, medicolegal concerns, and technological advances that led to this belief. All these themes were voiced in each group. Redberg noted: "People chose PCI for a number of emotional and other reasons and these reasons seemed to be largely independent of financial gain, as salaried and non-salaried physicians gave similar responses." As well as the commonly expressed belief that achieving an open artery was of prime importance, a major reason given for performing PCI was to relieve ischemia, irrespective of the patients' symptomatic status and evidence that coronary stenoses did not match with ischemic regions. Anecodotal experiences, including sudden death due to myocardial infarction of an asymptomatic patient, feelings of anticipating regret at not performing PCI, and a perception of low risk associated with the procedure, were also commonly voiced. Relieving patient anxiety was also cited by many physicians as a reason for testing for CAD in asymptomatic patients. Many participants said they believed that they might face legal action for not intervening, for example in an asymptomatic patient who subsequently suffered a cardiac event. Finally, participants thought that technological advances had increased the number of asymptomatic patients being referred to their clinics, and that they should treat these patients aggressively. They also felt the advent of drug-eluting stents had lowered the threshold for performing PCI because of the reduced chance of restenosis. Особенно понравился комментарий: Commenting on what might underlie the discordance between the cardiologists' knowledge of clinical evidence and their perceptions, Redberg said: "Cardiologists favor an open artery, perhaps because they are quite driven by pictures (angiograms) and feel compelled to 'fix' the lesions seen on angiograms, even if there is a lack of data to show a patient benefit." She said that the issue needed to be given a higher profile, particularly in light of findings from COURAGE and recent reviews of drug-eluting stent safety. 
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#4
29.08.2007, 22:26
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Цитата:
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Линейный вид
