Cardiologist group removes 'inappropriate' from stent use guidelines

As studies and controversies mount over coronary stent overuse, the American College of Cardiology has entered the debate by softening the language it uses in published treatment guidelines. Stent manufacturers will want to watch closely how well the changes play out over the coming year.

Bloomberg reported that, starting in 2014, the ACC has banished use of the word "inappropriate" in reference to patients who don't need stent implants. Instead, the professional group recommends referring to those cases as "rarely appropriate." For patients where the use or avoidance of cardiac stents isn't clear-cut, the ACC has coined the phrase "may be appropriate" to replace "uncertain."

As the article notes, doctors don't have to use the language recommended by the ACC, whose panels of experts come out with treatment guidelines for a variety of cardiovascular diseases. But their recommendations carry weight with insurers, regulators and courts when problems or lawsuits come up. According to the story, the use of the word "inappropriate" (part of the ACC recommendations since 2009) has become problematic those disputes have cropped up.

Cardiologists who spoke to Bloomberg said the change will help remove the stigma behind the practice of elective stenting, created by a relatively small number of cardiologists who have faced allegations of over-stenting that has harmed patients. 

The ACC and other medical societies issued criteria for appropriate stent use in 2009, which covered a wide variety of factors including evidence for stenting and bypass surgery, the article explained. University of Miami cardiologist Robert Hendel, who helped push for the new wording, told Bloomberg that insurers and regulators have improperly used ACC and other society guidelines as they currently stand to challenge physician judgment in particular cases. Hendel said the new wording is intended to "avoid" the sensationalism of labeling stent use as inappropriate, and address the "visceral response" that regulators and payers have displayed when addressing questionable cases.

But the ACC changes won't come quietly. Bloomberg noted there are 700,000 coronary stent procedures performed each year now in the U.S., costing the healthcare system approximately $14 billion. The news agency also points out that 8 studies have now concluded that in patients with stable heart disease, stent use is about as effective as cheaper drug therapy. At a time when industry players are ferociously managing and cutting healthcare costs, scrutiny over cardiac stent use won't go away with a change in word usage over recommended guidelines.

- read the full Bloomberg story