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Saturday, June 23, 2007

Many of the doctors groaned: Patient’s choice of heart treatment options

Cynthia Cooper’s cardiac surgeon recommended surgery to treat her blocked and narrowed heart arteries. But her cardiologist told her to have a stent (a short tube made from a wire mesh) implanted instead.

"It can be extremely frustrating to have these different options thrown at you," said the 72-year-old resident of a Boston suburb. "Why not meet with all the doctors at one time? It would be much easier for the patient."

Three years ago, a surgeon recommended a coronary artery bypass graft (CABG) for her because he believed it was the safest and most reliable option. But Cynthia had already undergone several abdominal surgeries, and was reluctant to have another operation.

So she asked her cardiologist. "I said to him, 'If I was your mother or your sister, what would you tell me to do?'" He advised a stent. She chose an angioplasty, a procedure that inflates a balloon inside the artery to clear the blockage. A stent was implanted to keep it open.

Several weeks later, surgeons and cardiologists discussed her case during Clinical Crossroads, while she sat in the audience, anonymous. The group overwhelmingly decided that her situation warranted surgery. When she told them she had chosen a stent instead, many of the doctors groaned. The Journal of the American Medical Association published the debate over her case in November 2004, and plans a follow-up article.

Cynthia still believes she made the right choice. Her last checkup, three months ago, showed the stent is working perfectly.

Advice to patients considering diverse options:
Get a patient advocate to help you decide.

Read another of our stories about a patient’s correct and difficult choice, or read Liz Kowalczyk’s source story in the May 29 issue of the Boston Globe.

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