The Case for Optimal Medical Therapy
Optimal medical treatment (OMT) first—before stress tests, stents, and bypasses— for heart artery disease is the new guideline directed standard of care from the American College of Cardiology. We finally got to that point in 2020. British guidelines focused on OMT delivered by primary care for heart artery disease in 2011. The Brits and other Europeans are much further along with translating that recommendation into practice. The Europeans get better results for less money. Leading American cardiologists called for OMT to be the universal standard of care going back to 2015. OMT at the national level improves outcomes and reduces costs compared with countries that have not effectively made the change.
There is one state in the United States that promotes OMT adoption and reports the achievement of OMT by medical group for almost 500 institutions. They have the lowest heart attack death rates in the country. Areas that are more resistant to change have much higher rates. There is a lot of regional variation. See the map. A practice in Colorado that provides OMT for 12,000 patients with arterial disease reduces death after a heart attack by up to 90% while saving tens of thousands of dollars per patient per year.
Fifteen studies comparing OMT alone with OMT plus a stent have shown that a stent adds nothing to OMT in patients with stable artery disease except cost and risk. OMT studies in diabetes also show dramatic benefits compared with usual care.
OMT produces better health at lower cost at the national level, the state level, and at the health system level. There is a mountain of research that prove it is much more effective than the care that most Americans receive. There is a mountain of evidence that proves opening arteries adds nothing but cost and risk to OMT in patients with stable artery disease. It is a proven product. A great deal of the research was done here, but other countries are reaping the benefit of reducing death, complications, and cost.
There are many healthcare solutions in the cardiometabolic space, and many different claims are made. Most making those claims don’t have data to back them up. If they don’t have data, their claims are worthless. If they do have data, it points to a hypertension control rate of 90% compared vs. a national control rate of 44%. They point to a sugar below the diabetic range and claim they have reversed diabetes. Don’t be taken in. That is great but it is insufficient. Hypertension and glucose control are intermediate outcomes, and they are only two of several that are critical.
Optimal medical therapy changes hard outcomes in cardiometabolic conditions. OMT is defined by achieving concurrently blood pressure control, glucose control, LDL cholesterol control on a statin, not smoking, and taking aspirin if you have vascular disease or chronic kidney disease. A high percentage of OMT achievement reduces hard outcomes—the outcomes that matter—death, heart attack, stroke, kidney failure, heart failure, amputations, blindness, revascularization procedures, hospitalizations, ER visits, readmissions, and total healthcare costs. THAT is what matters! That bold statement has been proven at the level of controlled clinical trials, an individual state in the US, and at the national level. Anything less than OMT does not meet the standard of care.
Taken together these facts prove that OMT is the care that patients with artery disease, heart disease, and should receive. Solutions that do not include this concept for vascular, heart, and vascular disease will predictably be inferior to this proven approach. Join us in making OMT more widely available in this country. It may save YOUR life!