Late surgery condemns heart patients to death

By MARTIN JOHNSTON health reporter

Heart patients may be dying because New Zealand does not fund surgery early enough.

A Scandinavian study shows that patients do better and their death rate is lower if they have surgery early.

Some cardiologists say the study into heart disease, one of New Zealand's biggest killers, shows the health sector should spend far more on the early treatment of unstable angina, which is usually caused by constricted heart arteries.

Tauranga Hospital cardiologist Dr Hitesh Patel said many patients were suffering and dying needlessly because New Zealand's treatment regime was so conservative.

First-year findings of the study of 2457 patients with unstable coronary-artery disease, who were split into two treatment groups of the same size, are published in Lancet, a British medical journal.

Of those in the "invasive" treatment group, 71 per cent were given heart-artery-bypass surgery or angioplasty within 10 days, compared with only 9 per cent of the "noninvasive" group, which received treatment that was more conservative.

Angioplasty involves expanding a section of narrowed artery by inflating a small balloon inside it. The balloon is inserted into an artery at the groin and guided to the heart. It is removed after the expansion, although in many cases it is used to expand a small metal "stent" which remains to keep the artery wide.

The operation was performed on National Party leader Jenny Shipley last month.

The Scandinavian study found that after one year, 27 patients in the invasive group had died, compared with 48 in the non-invasive group. There were also fewer heart attacks (105 against 143) and hospital re-admissions (451 against 704).

In New Zealand, heart disease causes more than a quarter of deaths, with men at more risk than women.

Cardiologist Dr Mark Webster, of Green Lane Hospital, said adopting a more aggressive regime with unstable angina would require more funding.

But in addition to reducing the death rate, it would save money by cutting the number of heart attacks, the number of hospital re-admissions and the length of stay.

Dr Patel said 90 per cent of the study's invasive group had received an angiogram test within 10 days. Only 15 per cent of Tauranga patients were given the test by that point, and other parts of New Zealand were similar.

Some Tauranga patients were waiting more than eight months for bypass surgery, although the delay was less for angioplasty.

He said the benefits for New Zealand patients if the regime of the invasive group were adopted could be even better than the study results, since NZ practice was so conservative.

A Health Funding Authority chief clinical adviser, Sandy Dawson, said his organisation would evaluate the study with "all the other evidence that's developing about improved treatment for people with coronary artery disease."

Average waiting-time data was not immediately available but he said: "Some areas already offer an acute angioplasty service, and we are very interested in evaluating this in association with other improvements …

"There are lots of opportunities for improving [our services] and we just need to make sure we get the best value for the money because … it's still limited."