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Consumer Reports

Slowing down the rush to heart surgery

Sometimes, heart disease erupts as a full-blown emergency with sudden, crushing chest pain. That’s when immediate intervention to restore blood flow to the heart can be lifesaving.

But in many situations, the path to aggressive care moves faster than called for, which can lead to overtreatment as well as worse outcomes and complications, says William Boden, M.D., a professor of medicine at the Boston University School of Medicine.

Boden and other experts suggest that when it’s not an emergency, slow down and do more research so that you can make smart decisions. That involves talking with your doctors about everything from whether you really need an expensive imaging test or invasive procedure, to which hospital to choose if you do need surgery. And if you feel rushed into making a decision, “ask for a second opinion,” Boden says.

Consumer Reports provides two key questions to ask along the way:

— Do I need that test?

The heart disease treatment odyssey often starts on a treadmill in a doctor’s office, as part of an exercise stress test. That test can be essential if you have symptoms that indicate heart disease, such as chest pain while exercising, or if you’re at high risk of a heart attack.

But some doctors include exercise stress tests as part of routine checkups, or as a safety check in people heading to certain surgeries.

Experts Consumer Reports spoke with said that’s generally not a good idea, in part because in people without symptoms of heart disease, the test is often more likely to reveal a harmless abnormality than identify a real problem.

— Are drugs or stents better?

If you do undergo a stress test and it has abnormal or uncertain results, your doctor will probably refer you to a “cath lab,” or catheterization laboratory, for more tests. And that’s where the cascade of procedures often speeds up.

In that lab, a physician first performs coronary angiography, which involves threading a thin tube into an artery and injecting a dye so that narrowing shows up on an X-ray.

But patients are sometimes asked to sign a consent form that allows doctors, if they see restricted blood flow, to immediately perform a procedure called angioplasty to remove the blockage.

That’s not usually necessary, Boden says. “What should happen is hitting the pause button and having a thoughtful, transparent discussion of all the treatment options.”

Performing an angioplasty involves a doctor inflating a thin balloon in the artery to widen it at the blockage, leaving a stent in place to prop the blood vessel open. It can be lifesaving when performed within hours of a heart attack.

But in other circumstances, lifestyle changes plus drugs to control blood pressure and cholesterol levels and prevent clots is at least as effective and usually safer, Consumer Reports notes. A 2016 review in JAMA Internal Medicine found that approach could cut the number of angioplasties by 80 percent.

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