COST & CARE: COST of Restenosis Prevention vs. Treatment, CATH is Not Necessary for All Heart Failure Patients, INDIVIDUALIZE Treatment of 'Partial' Heart Attack

April 1998

Media Contacts: Sarah Goodwin, 404/727-3366 - sgoodwi@emory.edu
Kathi Ovnic, 404/727-9371 - covnic@emory.edu
http://www.emory.edu/WHSC/

ATLANTA -- "Cost effectiveness analysis may help guide the choice of therapy and in setting policy over use of scarce resources," said Williams S. Weintraub, M.D., a cardiologist and epidemiologist at the Emory University School of Medicine, in Session 1027, Poster No. 49, recently presented during the American College of Cardiology (ACC) Scientific Sessions.

Dr. Weintraub has compiled a large body of work looking at the cost of cardiac care and its implications for prevention and future research; a sampling of his ability to evaluate coronary care through the eyes (and calculator) of a public health epidemiologist is outlined, below, in summaries of abstracts to be presented at this week's ACC meeting:

RESTENOSIS: COST OF PREVENTION VS. TREATMENT

Presented 7 p.m., E.S.T., Sunday, March 29, 1998

"Cost of Clinical Restenosis and Cost-Effectiveness of Therapy to Prevent It" William S. Weintraub, (Division of Cardiology, Department of Medicine, Emory University School of Medicine) Session 1027; Poster No. 49 - Presentation: 5-7 p.m., March 29, West Exhibit Hall, GWCC

Restenosis (a renarrowing of coronary arteries after treatment) costs nearly $10,000 per patient in a study of 5,795 patients with coronary artery disease evaluated by Emory's William Weintraub, M.D. Of the total patient group, 1,131 or 19.5 percent of patients developed restenosis. Using this data, Dr. Weintraub calculated that "if the effectiveness of preventive therapy is 50 percent and the cost of therapy $2,500, it will cost $16,000 per event prevented; if cost of therapy is $1,000, cost of event prevented falls to $633."

He says current research into the prevention of restenosis such as radiation after angioplasty or more biocompatible stents is particularly promising in light of this cost analysis. "Restenosis (a renarrowing of coronary arteries after treatment) is likely to remain a problem after PTCA (percutaneous transluminal coronary angioplasty), until inexpensive, highly effective preventive therapy is available," he concludes.

CATH FOR HEART FAILURE? ONLY SOMETIMES

Presented 2 p.m., E.S.T., Mon., March 30, 1998

"Do All Patient with Congestive Heart Failure Need Diagnostic Coronary Arteriography?

Thomas S. Johnston, Jerre Lutz, Andrew L. Smith, William S. Weintraub,

(Division of Cardiology, Department of Medicine, Emory University School of Medicine)

Session 1044; Poster No. 40 - Presentation: 1-2 p.m., March 30, West Exhibit Hall, GWCC

Not all patients diagnosed with congestive heart failure (CHF) necessarily require cardiac arteriography (also called cardiac catheterization or CATH), even though coronary artery disease (CAD) often leads to CHF, says William S. Weintraub, M.D. "...patients with heart failure may be stratified, similar to patients with chest pain, with low risk patients needing no further testing, intermediate-risk patients requiring noninvasive evaluation to modify the probability of coronary artery disease prior to the decision on performing or not performing CATH and high risk patients often requiring CATH for anatomic definition and possible revascularization," Dr. Weintraub concludes in his multivariate analysis of 392 patients without heart attack or CAD who underwent CATH. Patients with congestive heart failure had 2.26 the odds of developing CAD if they were male, 4.74 the odds if they had diabetes and had 1.68 the odds (per decade of advancing age) of developing CAD. "Chest pain was not predictive of coronary disease in this population," he concludes.

MANAGE NON Q-WAVE (PARTIAL) HEART ATTACK CASE-BY-CASE

Presented 7 p.m., E.S.T., Sunday, March 29, 1998

"Long-Term Outcome of Patients with Non Q-Wave Myocardial Infarction with or without Revascularization" Ziyad Ghazzal, Prasad Chalasani, Yannan Shen, William S. Weintraub

(Division of Cardiology, Department of Medicine, Emory University School of Medicine)

Session 1003; Poster No. 128 - Presentation: 5-7 p.m., March 29, West Exhibit Hall, GWCC

"In patients who suffer a non Q-wave myocardial infarction (heart attack in which only a partial thickness of heart muscle wall is damaged), management should be individualized," reports Dr. Weintraub and Ziyad Ghazzal of Emory. "The long term survival between the medical and revascularization groups (in their one- and five-year followup evaluations of 403 patients who had a non Q-wave MI) is not statistically significant."

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