Taking a dig at commercialisation of heart care services, eminent cardiovascular and thoracic surgeon Dr TS Mahant on Saturday rapped cardiologists for being more oriented towards business than serving patients.
Dr Mahant, who is the executive director at Fortis Hospital, SAS Nagar, said patients who could be treated with surgery at much lesser cost were being looted by implanting expensive heart stents.
The doctor said there was enough evidence that expensive stenting was carried out in patients who actually needed surgery, such as Cardiovascular Artery Bypass Graft commonly known as bypass surgery.
He was speaking at a continuing medical education (CME) programme held in a city hotel on Saturday night.
When asked specifically about Fortis hospital remaining in controversy for such malpractices, he said he was aware of the fact. “I have always raised the issue in our joint meeting with the cardiologists,” he said, adding that now things had gone from bad to worse, and hence he chose to bring the matter to public notice.
The cardiologist said now newer and more expensive varieties of heart stents were being introduced. With doctors recommending these stents, patients were at the receiving end, he added.
‘Studies support bypass surgery’
Dr Mahant said two international research studies had conclusively revealed that Cardiovascular Artery Bypass Graft (CABG) was more effective in saving lives as compared to Percutaneous Coronary Intervention (PCI) or stenting with drug-eluding stents. “Freedom and ART trials are two of the biggest and long-term trials in the field of cardiac science the world over,” he added.
Speaking on the topic ‘Fifty years of myocardial revascularisation’, Dr Mahant said, “The first CABG procedure was performed in 1964. Thirteen years later, the first PCI was performed and the CABG vs PCI debate has been ongoing since 1979, when balloon angioplasty started. This debate has finally been settled after the publication of five-year outcomes of the Syntax and Freedom (in patients with diabetes) trials accompanied by supportive data from several large registries. It has been established that mortality has been consistently reduced by CABG, as compared to PCI, in more than 4,000 patients with diabetes who have been evaluated in 13 clinical trials.”
‘Risk equivalent in surgery, stenting’
Talking about the fear of surgery in both options — surgery and stenting — Dr Mahant pointed out that this was immaterial as the risk was equivalent in both options. “What is important,” he advised the doctors at the CME, “is that proper and right advice be given to the patient about the options — whether he needs CABG, PCI or medical management. In addition to optimal medical therapy, some patients with coronary artery disease also require intervention on symptomatic and/or prognostic grounds.”
“Nowadays, of the 100% patients who need a bypass, approximately only 54% are advised the CABG procedure. Close to 30% are advised PCI, as a result they end up paying much more for treatment, he added.
Fortis around five years back had gifted BMWs and Mercedes to its doctors, mostly cardiologists, for getting good business.