Poor heart care 'costing lives'

Many patients are not offered surgery

Bad decisions by individual doctors are costing the lives of heart patients, say experts.

The British Heart Foundation (BHF) says reforms are urgently needed.

Scientists from Kensington, Chelsea and Westminster Health Authority investigated the way decisions on treatment are currently taken.

They found that many patients are not being offered the surgical procedures most likely to improve their condition - resulting in a poor quality of life, and in some cases, premature death.

Doctors are routinely having to make life and death decisions about a patient's treatments without being able call on the advice of an external clinician

Dr Harry Hemingway, Kensington, Chelsea and Westminster Health Authority

The problem is that many doctors take decisions in isolation without consulting other specialists.

Lead researcher Dr Harry Hemingway, said: "We have uncovered a worrying situation, whereby doctors are routinely having to make life and death decisions about a patient's treatments without being able call on the advice of an external clinician.

"In this situation, doctors may be under-using bypass grafts and angioplasty."

Dr Hemingway said expert panels should be introduced to help individual doctors decide the best course of action.

The guidance would be based on a range of patient case histories.

Computer access

Individual clinicians would be able to access the guidance by computer.

Dr. Hemingway said: "Our findings will inevitably cause controversy as they challenge conventional clinical practice, in which the decision of the single specialist is considered sovereign.

"In future, patients who are not offered surgery could reasonably query what the recommendations of the expert panel were."

The recommendation is based on a study of the care of more than 2,500 patients.

It was decided that 1,353 of these patients would have benefited most from coronary artery bypass graft surgery.

However, more than a quarter were treated with drugs instead of undergoing surgery.

Death rates were higher among these patients, who were also more likely to suffer a non-fatal heart attack.

The research also revealed that more than a third of angina patients were denied the best treatment for them - a surgical procedure known as coronary angioplasty which increases blood flow in furred arteries.

Sir Charles George, BHF medical director, said: "The recommendations of this exciting new study provide us with an effective way of ensuring that every heart patient can be considered for the best treatment available, based on their individual needs.

"A nine strong expert panel could give doctors an opportunity to gauge the opinions of the UK's leading cardiac specialists at the touch of the button, bringing very real benefits for the patient."

The research team hopes that the first pilot schemes of this project will be running within the next 18 months.

The research is published in the New England Journal of Medicine.