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A Passing Stent

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Is the insertion of stents as an accepted cardiological procedure going to become a thing of the past? For Interventional Cardiologists, such a question may sound absurd.

According to Joe Cantlupe over at HealthLeaders Media, Lawnwood Regional Medical Center, part of the gigantic HCE hospital chain whose profitmaking and health-providing methods are being scrutinized on several levels, was found to have conducted 1,200 needless cardiac interventions.

Also part of the debate is whether medical therapy and management is just as effective as angioplasty or stent placement for such conditions as angina. The studies are inconclusive, but a few have been released favoring stents, one by the Mayo Clinic in 2009 that showed a 25-year improvement on PCI success and mortality rates, even as comorbid conditions increased.

In fact, it could be argued that most cardiologists feel that stents, when appropriately used, are still the safest and most effective procedure for their patients. It’s the inappropriate use that is troubling, since that’s when the procedure, quite obviously, becomes dangerous.

Still, the very fact that the stent debate is happening is worthy of a watchful eye.

Cardiovascular surgeons saw their volumes decrease significantly when stents reduced the need for cardiac surgery for many patients. What if stents become subject to scrutiny? Will cardiovascular surgery volumes experience a significant increase? Will interventional cardiology volumes plummet?

Could it mean that interventional cardiologists will spend less time in the cath lab and more time performing general cardiology work? How will this all affect volumes, and the careers of cardiologists?

Look at the market for cardiovascular surgeons, for example. There is an oversaturation of cardiovascular surgeons to the point that many are finding it extremely difficult to find a practice. Many are being forced to practice as general surgeons, or to repeatedly do fellowship after fellowship because they are unable to find good jobs and they don’t want to lose their skill set. Will added scrutiny result in an decrease in interventions, and an increase in cardiovascular surgery?

And finally, what will this do to incomes, as interventional cardiologists make much more than non-invasive cardiologists?

If stents are relegated to the past, the impact that this could have on cardiology jobs and cardiologists looking for those jobs is inestimable and worth at least a minimal degree of speculation.

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