A conversation with Aubrey Nuss, Director of the Heart and Vascular Center at Hutchinson Regional Medical Center
The highly publicized results of the NIH-funded ISCHEMIA trial were presented at the 2019 American Heart Association’s yearly conference recently, comparing medical management and more invasive interventions such as stents and surgery. The study proved there is NO difference in mortality (death) between medical management and stents or by-pass surgery in STABLE heart disease. GASP! Was the cardiology community shocked, stunned, … afraid? No. Most cardiologists will confirm this is not new information.
Personally, I was surprised by the media coverage and the questions I received over the trial results. We don’t bring patients to the catheterization, or “cath” lab for STABLE heart disease. It’s only appropriate to have a heart cath if you are having symptoms of unstable heart disease, a heart attack, or have failed optimal medical management. The media coverage also did not promote the additional trial results that stents were better for improving angina symptoms over medical management. At 1 year, over half of the study subjects that received stents were still angina free, compared to only 20% of medically managed patients. It’s common for patients to receive a stent to control their angina symptoms and have a better quality of life. Gregg Stone, MD, one of the ISCHEMIA investigators stated, “I think this trial supports either an invasive or a conservative approach for patients with stable disease (who have) either no symptoms or mild symptoms that can be controlled with medications…it tells you that you can safely (stent) patients with moderate or severe (heart disease) and they will feel substantially better if they had angina at baseline.” Most media reports only reported the study’s findings on the QUANTITY of life and not the findings of the QUALITY of life.
As Director of the Heart & Vascular Center at Hutchinson Regional Medical Center, I have a fear that the community will misinterpret these results, and that people might disregard symptoms that should be investigated immediately or worry that their stents may have been unnecessary. My best piece of advice is to find a cardiologist you trust and have open communication with them. Tell them what you have heard on the news or social media. They will be happy to let you know if the latest treatment option is right for you, or why it’s not right for you. Let them know what your goals are. Do you want to live as long as you possibly can? Do you want to be able to play golf or walk with your grandchildren without chest pain? How about doing your own grocery shopping without a scooter? Your primary care physician and cardiologist can work with you to assist in making those things happen. The ISCHEMIA trial results should not change how your cardiologist and primary care physician manage your heart disease. It also doesn’t mean the treatment you have received is wrong. Reno County is very fortunate to have a large health care community to see to your every need and I’m exceedingly proud of our care of cardiac patients. Also, if or when you need a heart catheterization, the Heart & Vascular Center will be happy to provide you with exceptional, personalized care using the latest technology.
Lastly, if you believe you are having a heart attack, call 911. Don’t drive yourself to the hospital! Reno County EMS is trained to start treatment right away in your home. They are able to detect a heart attack early and have the ability to notify the hospital and the cardiologist prior to your arrival. This will get you to definitive care sooner and improve your chances of a full recovery.