Beware of stents Are many heart surgeries unnecessary?

Experts criticize increase in operations with stents

07/25/2014

The use of stents is standard in narrowed blood vessels and arteriosclerosis in the heart. According to the current hospital report of the health insurance Barmer GEK, the method could be used but too often. In 2013, three times as many treatments were performed with stents in 2013 than in 2005.

Three times more operations with stents
Last year, stents were used in 204,402 cases of constricted blood vessels in the heart. However, patients who suffer from many constrictions in unfavorable places usually still require a bypass. However, this procedure is much more stressful for the person concerned, since the chest must be opened. The number of these operations has fallen by 24 percent since 2005 to 52,951 cases.

There is a distinction between coated and uncoated stents. Previous studies suggest that stents coated with a drug are highly promising in certain patient populations, reducing the likelihood of retreatment to 3 to 4 percent over other methods. The studies refer to examinations in which patients were followed for between six and 60 months.

According to the Barmer GEK, however, this positive effect does not always appear in reality. The cash register report shows that 4.6 percent of those insured with stent need to be treated again within one year. After every five years, even one in three stent patients has to undergo therapy again, while in bypass patients this only applies to one in five.

How to explain the increase in treatments with stents?
„Coated stents are likely to be the standard treatment for constricted coronary vessels today. However, we wonder whether this increase can only be medically justified or whether the price influences the amount of intervention, "explains Dr. Rolf-Ulrich Schlenker, Deputy Chairman of the Board of Barmer GEK The use of a stent costs about 5,500 euros, a bypass surgery beats with just under 20,000 euros to book. According to the study authors, stents are quite cheap for the hospitals, so that their use in the amount could be worthwhile.

Experts and cashier representatives demand more specialization, so that plannable interventions, such as the heart surgeries, are concentrated on particularly experienced houses. This is already the case with bypass surgery, which is only offered in 70 specialized hospitals of the approximately 2,000 hospitals. Currently, more than 800 houses offer the gentler methods for the expansion of the heart vessels, write the study authors. That's too many.

With regard to the upcoming hospital reform, which the federal government, states and coalition experts have been discussing with the public since May, Schlenker demands: „We primarily advocate new hospital requirements planning, which does not just update the capacity of beds, but promotes the regional care situation and the qualitative specialization of hospitals.“ (Ag)