Overpricing, over-prescription costs Chinese cardiac patients

When a 70-year-old resident of Guangzhou, Guangdong Province, surnamed Zhong, went to the doctor after chest pains, the doctor diagnosed him with angiostenosis, a condition in which blood vessels narrow, and suggested he have a heart stent implanted.

The anxious Zhong agreed immediately, but his daughter insisted he consult with other cardiologists.

After meeting with other doctors, Zhong was diagnosed with a simple gastroesophageal reflux. Zhong only needs to drink hot milk to solve the problem, instead of having a complicated and expensive medical process, the Xinhua News Agency reported.

Percutaneous coronary intervention (PCI), or balloon angioplasty, is a complicated but non-surgical procedure used to treat the narrowed coronary arteries of the heart which can cause heart attacks and angina. During the process, a stent is often implanted in the widened passage to help keep it open permanently.

The Beijing Youth Daily on February 11 cited a Beijing-based cardiologist as saying that the technique can reduce the death rate of myocardial infarctions (heart attacks) by 3 to 4 percent. But experts and the public remained concerned over the high cost and over-prescription of heart stents.

Popular treatment

There were just 20,000 artery intervention operations in China in 2000 but the figure had swollen to 408,000 in 2011, Xinhua reported. Doctors implanted an average of 1.59 heart stents in each operation between 2009 and 2011, the Beijing Youth Daily reported.

An alternative treatment to PCI, coronary artery bypass grafting (CABG), commonly known as a heart bypass, removes a leg vein through small incision to create detours around clogged heart arteries.

The proportion of PCI to CABG worldwide is 7:1 to 8:1 while the ratio in China is 15:1, according to the Beijing Youth Daily.

Compared to a heart bypass, PCI has fewer risks and does not involve surgery, which made it more popular among patients and doctors, especially in local hospitals, Xinhua reported.

Yan Ke, an experienced doctor from Anhui Province, told Xinhua that many patients were afraid of heart surgery and some doctors were afraid of losing patients during surgery which could easily spark medical disputes. Yan said that heart bypasses require a high level of skill in doctors, requiring patients to go to big hospitals in Beijing, Shanghai and Guangdong Province, while PCI is easier to do.

There are no follow-up studies on the efficiency of Chinese PCI. However, medical experts have noted that overuse of heart stents is clear in the figures, though they admit the operation is an effective way to cure heart diseases.

Hu Dayi, a cardiologist at Peking University People's Hospital, said that 12 percent of patients have been "over treated" and 38 percent of heart stents were implanted unnecessarily.

A patient in Chifeng, Inner Mongolia Autonomous Region, had nine heart stents implanted to cure coronary heart disease though a doctor has told him previously he only needed one to two, The Beijing News reported in June. The patient spent 150,000 yuan ($24,000), but he got worse after the operation.