JAMA: Comparative heart study didn't change treatment

Four years ago, a highly publicized study found that cardiac stents didn't reduce the risk of heart attack or death any better than high-quality treatment with certain meds did. But even though drug therapy is much cheaper, treatment strategies haven't changed much. Almost as many patients with clogged arteries still get stents rather than take medications, a new study in the Journal of the American Medical Association has found.

Before the Courage study appeared, less than half of patients were given the gold standard of heart-drug therapy before an angioplasty procedure. Afterward, the rate was about the same, the Wall Street Journal reports. Plus, the study didn't improve post-angioplasty drug therapy either. Patients got optimal drug treatment at about the same rate afterward as they had before.

The JAMA analysis highlights some of the pitfalls of comparative-effectiveness research. After the Courage results appeared, stent makers and doctors criticized the data, casting doubt on its validity. Plus, doctors are typically paid more for implanting devices than they are for keeping a close eye on patients, so there's a financial incentive to choose stents over drug therapy.

There are two take-aways from this new research. Comparative effectiveness data alone won't shift treatment strategies. As Forbes points out, Courage wasn't the only study to find no advantage for stent procedures in patients with stable blockages. Furthermore, with the right push, drugmakers might win a lot of patients over to first-line treatment with their products, rather than with angioplasty and stents.

- read the WSJ piece
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