Our Healthcare System Has High Rates of Preventable Care-associated Patient Injury and Death
The last three posts have discussed the clear reasons that our healthcare system fails to improve health and reduce costs in patients with chronic disease. Let’s talk again about patients with heart artery disease as an example care-associated patient injury and death. If a patient has chest pain that is typical of angina and it is relieved by nitroglycerin, it makes sense to start them on optimal medical therapy (OMT). The only reason to do a heart catheterization is to see if a stent is appropriate and they are rarely needed in stable patients. When a heart catheterization is done, they must use a dye to outline the arteries.
This dye can damage the kidneys in about 2% of patients. The risk increases in patients with diabetes, vascular disease, and chronic kidney disease. The risk of additional kidney damage in patients with chronic kidney disease and diabetes increases to 20-50%. These are the very patients who are most likely to “need” a catheterization. Many times, the kidney damage is reversible, but it is quite often permanent. That would be fine if the test is essential, but in stable patients it is not. Two patients in my family have died related to bypass surgery. One of my patients had a severe stroke. Another was demented after the surgery. The studies that lead to stent placement and bypass are not entirely benign. There are serious potential complications. These tests and procedures should only be done when they are really necessary.