Oct 11, 2012
By Dale Goldhawk
11:30am ET | Dr. Ko, interventional cardiologist
12:15pm ET | Darlene Shura, Principal
TOPIC – The study, just published in the Journal of the American College of Cardiology, looked at more than 1,600 Ontario patients with stable coronary-artery disease, meaning those who have not suffered a heart attack and are not experiencing “unstable” angina.
INFO – Pricey and invasive operations to unclog hardened arteries are frequently given to the wrong heart patients, burdening the health-care system with ineffective treatments on the one hand, while depriving others of the critical medical treatment they need on the other, a new Canadian study suggests.
Close to a third of the heart patients who receive artery-widening angioplasties and cardiac-bypass operations are inappropriate or merely borderline candidates for the surgeries who gain all but no benefit from them, researchers concluded.
At the same time, many people who should certainly undergo the procedures fail to get the operations, making them more likely to die or end up back in hospital.
To ensure such procedures are given to patients who truly need them, the authors recommend governments allow funding only when expert guidelines for the operations are followed by hospitals and doctors.
“We need some help. We need to improve on when to do these kind of procedures,” said Dennis Ko, lead author of the study funded in part by the Toronto-based Institute for Clinical Evaluative Sciences (ICES). “We want to do everything we can to better use our scarce health care resources.”
The prevalence of coronary disease has been declining steadily in Canada in recent decades, but it is still among the country’s leading causes of death, and treatment of the problem costs the health-care system billions annually. While the per-capita rate of bypass operations has been falling, the rate at which doctors performed angioplasties, considered safer and less costly, doubled during the 2000s, according to the Canadian Institute for Health Information.
The study, just published in the Journal of the American College of Cardiology, looked at more than 1,600 Ontario patients with stable coronary-artery disease, meaning those who have not suffered a heart attack and are not experiencing “unstable” angina. Such patients can be treated medically, with drugs and possibly lifestyle changes. Or they can be given procedures such as a bypass — open-heart surgery where a blocked artery is replaced with a vessel taken from elsewhere in the body — and angioplasty, which uses minimally invasive techniques to inflate a tiny balloon or insert a vessel-stretching stent in the vessel.
The study found that 32% of those who received either bypass or angioplasty were rated “uncertain” candidates for the operations or inappropriate, and on average they received no benefit from the procedures.
But more than 30% of the 991 patients who were considered to be appropriate choices for procedures never received an operation, perhaps because of undue concern by doctors about the operations’ side effects.
Dr. Ko, an interventional cardiologist at Toronto’s Sunnybrook Schulich Heart Centre, said some funding bodies in the U.S. are talking about linking use of the appropriateness guidelines to hospitals and doctors being paid for a procedure, a financial incentive he said should probably be considered at some point here, too.
One specialist, though, questioned the study’s results, noting they were based on observation of patients after the fact, not a randomized, controlled trial, considered the gold standard of medical research.
Dr. Colin Rose, a Montreal cardiologist and outspoken critic of pharmaceutical and surgical treatment of coronary-artery disease, said other research suggests operations are no better than non-surgical therapy for stable patients.
“The bottom line is that in stable coronary disease, [procedures] do not prolong life,” argued Dr. Rose. -NATIONAL POST, TOM BLACKWELL
TOPIC – International Plain Language Day and consumers
INFO – “Think what the world would like if we could all understand our bills and account statements at a glance, if contracts and sales agreements were written in plain language, if we could understand how to correctly apply for government programs and services, the first time. What if we all had a lot less gobbledeegook to read every day? What happy, busy zoomer has time for that?” – Darlene Shura
Saturday October 13 is International Plain Language Day and events are being held in Toronto and around the world to raise awareness of why plain language matters — and how it benefits business, government and consumers. Zoomers can learn about the plain language movement and how it is working to make their lives better. For instance, many people don’t know that there are laws in Ontario to protect the public from unclear contracts.
To celebrate Plain Language Day in Toronto, we are inviting the public to drop by the ING Direct Café at Yonge and Shuter Street on October 13th from 2 to 4 pm. Those who do can:
§ See examples of plain language and how it can make everyday items like utility bills, government notices and bank statements simple and easier to read. Studies worldwide show the time and cost savings amount to millions of dollars in some organizations.
§ Join the first ever Toronto Plain Language Challenge. We plan to hand out awards for the best and worst examples of business and government materials. We will invite members of the public to nominate documents for these awards over the next year. Details will be released at the event.
§ Chat with plain language experts to learn more about plain language.
Consumers need to demand plain language from their businesses and governments. It’s the key to building an inclusive, democratic society. If you have a passion for clear consumer communication, I would welcome the opportunity to talk to you and your listeners and tell them about the international plain language movement and Plain Language Day.