New guidelines set for heart treatments

Duke doctor leads panel on criteria

Patients with heart blockages will be assessed for surgery on a new set of guidelines designed to bring more consistency to who gets the interventions.

More than 1 million Americans have angioplasties, in which a balloon is used to open blockage in an artery, and another 500,000 have the more invasive heart bypass surgery to restore blood flow.

But the nation's largest professional groups of heart doctors, including the American College of Cardiology, said Monday that some patients are getting the procedures unnecessarily, while others who need them may be denied. As a result, the groups wrote a new set of guidelines to rate patients based on their symptoms and the severity of their condition.

Dr. Manesh Patel, a cardiologist at Duke University School of Medicine, led the group that wrote the criteria. Patel said the first question patients need answered is whether they should undergo a procedure to restore blood flow to the heart.

"What we tried to do is assess when it's reasonable to undergo this procedure to improve health, symptoms or length of time that patients live," Patel said.

HOW ARE PATIENTS RATED? Doctors look at a patient's symptoms, plus the results of tests and imaging scans to determine the extent of the blockage and how severe the damage is. Using a grading system, patients are given a score between 1 and 9. Those who score high are most appropriate for surgical interventions. Those with lower scores are not recommended for the procedure, while the middle group is uncertain.

WHO BENEFITS FROM THE NEW SYSTEM? Patel said patients, insurers and doctors should see more consistency in who gets surgical interventions.

WHAT'S THE DOWN SIDE? Some doctors may chafe at a set of guidelines that may not account for a patient's entire situation, while others may find the criteria too subjective.