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Patients underestimate risks, overestimate benefits of elective angioplasty

Yale Medicine Magazine, 2001 - Spring


When it comes to electing to undergo angioplasty, many patients believe that the procedure to open up clogged blood vessels can prevent heart attacks and prolong their lives without any significant danger. According to Yale investigators, this is a misperception and patients need a better understanding of the potential risks and benefits from their health care providers well before they undergo the procedure.

Angioplasty is an invasive procedure in which a balloon is inflated inside a blood vessel, most often a coronary artery, to flatten any plaque that blocks flow through the vessel. A metal device called a stent is often inserted to help keep the artery open. It can relieve chest pain, but there is no definite evidence to date that it will lower the risk of a future heart attack. Moreover, angioplasty itself poses risks of inducing a heart attack or stroke, as well as hemorrhage and infection. Eric Holmboe, M.D., assistant professor of medicine, and his colleagues interviewed 52 patients, ages 39 to 87, on the eve of the procedure about their views of the potential benefits and risks. Three-quarters believed the procedure would prevent a future heart attack, and almost as many thought it would prolong their lives. When asked about risks, less than half could recall a single risk associated with angioplasty. Results of the study appeared in the Journal of Internal Medicine in October.

“Our findings show that patients do not have the information they need in a format they can use to make the best decision about angioplasty for themselves,” says Holmboe. “In my opinion, patients need to have a discussion about the benefits and risks a good week before any elective procedure in order to think about the risks and benefits.” To achieve this goal, Holmboe plans to create a multifaceted approach to help inform patients and answer their questions and to set up a program to train young physicians to provide risk explanations patients can understand.