Informed consent before angioplasty

Most patients are not given informed consent.

Less than 2% of angioplasty patient are properly informed!

Before taking any prescribed drugs, or undergoing any form of elective treatment, in today's medical world it is assumed that the patient is informed about the need for the procedure, and also its risks and benefits. One of the most frequently performed

procedures in the Western world is coronary artery angioplasty, usually for patients with angina.  A recent study in the JAMA Internal Medicine makes horrifying reading.(click here).  In this paper 59 patients listed for coronary angioplasty had the discussion between themselves and their cardiologist concerning informed consent, recorded. (One would have thought the cardiologist knowing that he or she was being recorded would do better than usual).
There are seven basic elements to informed consent:
1. The patient knows they have a role of the decision.
2. Discussion of the issues and decisions at hand.
3. Discussion of the alternatives.
4. Discussions of the pros and cons of the alternatives.
5. Discussion of the uncertainties.
6. An assessment of the patient's understanding.
7. Exploration of the patient's preference.

Most patients believed that the procedure (angioplasty) reduces the risk of heart attacks and death, but in fact this is not correct. Angioplasty merely reduces the symptoms.

The findings of the study were very sobering – only 3% of the discussions included all elements of informed consent, and just 14% met a more limited definition of the procedure, alternatives and risks. 97% were good at discussing the procedure, but alternative procedures were offered only to 25% of cases. Also the majority of patients were not aware that they had a role in the decision-making process.

There is a real concern worldwide that coronary angioplasty is being performed a great deal more than it should be. There is no evidence, other than reducing symptoms that it does any benefit, and this is not what the general public believe. Even the conservative medical bodies and journals are beginning to discuss this, as not only is the procedure expensive, but it also does have significant risks, and there are other alternatives.

Make absolutely certain that any drug or procedure that you are about to undertake does more good than harm!