Risk/Reward Of Angioplasty. Worth It?

Angioplasty has been praised for its’ less invasive approach to fixing clogged arteries than the traditional bypass surgery by many and it has been labeled a dangerous scam by others.

In light of a couple of takes on angioplasty by CBS news this week I want to throw out some discussion about the subject from a life insurance standpoint and from a medical point of view.

Angioplasty has kind of devolved over the past ten years in the eyes of life insurance underwriters. At first seen as “the new and better way” to address clogged arteries, angioplasty received more favorable underwriting than the other surgical alternative, open heart bypass surgery. With, for instance, a 3 vessel angioplasty versus a 3 vessel bypass, in the absence of a heart attack, the angioplasty would have had about a two table edge in the past.

Today there is virtually no difference in the underwriting outcome between the two procedures. Mortality experience post procedure is almost identical and underwriters who once thought the angioplasty would have a better experience because it was less invasive now have enough data to dispel with that notion.

Then there’s the issue of overuse of angioplasty, whether you believe that’s because it’s so easy or it’s so easy and lucrative. The truth is that a doctor may be inclined to be too aggressive in using angioplasty because of its’ ease when the blockage could, in at least 30% or more of cases, be controlled and reversed medically. From an underwriting point of view there is a huge difference between someone diagnosed with coronary artery disease who is treated successfully with medicine and someone with an identical situation that undergoes angioplasty or bypass surgery. Whether right or wrong there is a perception that if surgical intervention of any type is warranted, the CAD must be more advanced.

Doctors often tout angioplasty as the safe way to address arterial blockage. The problem lies in the fact that the procedure is often done in non emergency situations where there is no real need for easy or fast. And it is often done in hospitals that don’t have a cardiology unit backup so if something does go wrong the option of open heart surgery is still available.

So, medically speaking, the question is drugs versus angioplasty? A 2007 study showed that in non emergency situations (no heart attack happening), there was virtually no statistical difference between the choice to have an angioplasty or take clot busting drugs.

Bottom line. From a medical point of view, in non emergency situations it certainly seems prudent for doctors to ease the panic of the situation and discuss the alternatives. Please understand that I would never suggest that someone dictate medical choices based on how it might affect future life insurance premiums. What I am saying is that it appears there is ample evidence of the overuse of angioplasty and that overuse is affecting patients far beyond the medical issue.