Quote: “Inappropriate” by any other name is …

The American College of Cardiology is changing its guidelines for when implanting coronary stents is appropriate — by banishing the term “inappropriate.”

With 700,000 procedures in the U.S. annually — at an estimated cost of $14 billion — appropriate use of coronary stents has become one of the hottest issues in cardiology. Eight studies have found stents are no better than drug-based therapy in preventing heart attacks and death in patients with stable heart disease.

Next year, the main U.S. heart-doctor group will remove the word it has used since 2009 to describe cases where people don’t need the metal-mesh tubes in their blood vessels. The label has become a liability in treatment disputes with insurers and regulators, said Robert Hendel, who led the effort that updated the wording.

“The term ‘inappropriate’ caused such a visceral response,” said Hendel, a cardiologist at the University of Miami. “A lot of regulators and payers were saying, ‘If it’s inappropriate, why should we pay for it, and why should it be done at all?’”

The cardiology group replaced the “Inappropriate” label with “Rarely Appropriate.” Another category — cases in which there’s medical doubt — will switch from “Uncertain” to “May be Appropriate.”

Peter Waldman, Bloomberg


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