Cardiologists Say Stents are Overused in China

China Daily has reported that more than half of heart stent procedures performed on mainland China are unnecessary. The allegation was made by cardiologist and President of the Chinese Society of Cardiology Hu Dayi, M.D., at the 23rd Great Wall International Congress of Cardiology, for which he acted as president.

“We’ve wasted lots of resources and haven’t solved patients’ problems,” he said. “Some people even turn out to be worse off with these unnecessary stent implants.”

Dayi urged health authorities to take action regarding insurance policy payments, clinical guidelines, regulations, monitoring, and the assessment of surgical outcomes as measures to reduce unnecessary stent implantations.

Currently, China has no formal registry system that tracks the number of heart stent surgeries that occur annually in the country. Official estimates have put the number at about 340,000 in recent years, second only to the United States. As China Youth Daily reports, citing an industry source, just 10 years ago the annual number of stent procedures was 20,000.

Last year, Paul Chan, M.D., a cardiologist at Saint Luke’s Health System in Kansas City, Miss., published a study in the Journal of the American Medical Association that concluded that stents were also being overused in the United States. “More than half of the inappropriate cases were in patients who didn’t have any symptoms at all,” Chan told Reuters Health. “If they are not benefiting, that’s a problem.”

Dayi referred to a 2010 study, which found that in the United States and the United Kingdom, half of patients who underwent a stent procedure for a condition other than a heart attack would have been fine without it. In fact, the study concluded that approximately 12 percent of the patients worsened after the stent procedure, suggesting they should have foregone the expensive procedure completely.

“The problem in China is far worse than that,” Hu warned. “An intentional overuse of stents has become common on the mainland, a practice that must be changed immediately.”

According to Dayi, only 10 percent of stenting procedures in China are performed in response to a heart attack. “That’s contrary to the situation in developed countries that have sound regulations and clinical management,” he said.

A stent is a small tube inserted in veins or arteries after doctors remove vessel blockages in a nonsurgical clearing procedure called angioplasty. They may or may not be drug-coated. Companies including Boston Scientific, Johnson & Johnson, and Medtronic all sell drug-coated stents in China.

Dayi suggested that it is the cost of the procedure that causes it to be recommended more than is strictly necessary. Performing stent surgery can be highly profitable and patients have been known to pay as much as 27,000 yuan (U.S. $4,500) for a domestically produced stent that carries a factory price of 3,000 yuan (U.S. $480).

The Ministry of Health in China has taken various steps to prevent the devices from being overused, including requiring collective assessments for surgery that uses more than three stents. Hu criticized hospitals for not properly adopting the steps mandated by the Ministry.

William A. Zoghbi, president of the American College of Cardiology, suggested that China establish a registry system for heart stent operations.

“With that we can know exactly how it is being used in a particular city or hospital and ensure medicine is being practiced properly,” he said.

Huo Yong, president-elect of the Chinese Society of Cardiology, said many heart attack patients in rural areas do not have the opportunity to undergo a stent procedure, either because they live far away from the places where those procedures are performed or because of economic reasons. According to his estimates, 600,000 heart attack cases occur in China annually but only 20,000 of them lead to the use of heart stents.

Photo of Dr. Hu Dayi. Screen capture courtesy of the European Society of Cardiology.