I mean I get it Old demented 90 y/o Probably doesn't have much to live but if she has symptoms and potentially stenting a clogged artery might relieve her symptoms why not just do it assuming she can tolerate the procedure. Same with those patients with widespread metastatic disease.
Why dont cardiologists like to Cath Old demented patients or Cancer patients?
- Thread starter Cadet133
- Start date
You have to consider the risks of these procedures. The sedation for the procedure could cause them to aspirate or become delirious (esp in the demented 90 year old). After putting a stent in a demented pt, can you guarantee she will take DAPT, because if not, she rethrombose the stent and has another MI. What if the contrast pushes their kidneys over the edge, would you offer them dialysis? Would a demented pt lay flat for 4-6 hours after the procedure, because if not, she reopens the arterial access site, and now she has an arterial bleed that you have to hold pressure on, and restart the flat time, which may develop into a pseudoaneurysm or fistula. Are they even active at baseline, because if they are very frail and bed-bound, what are you trying to achieve with the LHC? 90 yr old demented pt tend to fall and end stage cancer pts tend to be pancytopenic, what if they fall while on DAPT.
Don't focus on how a procedure might help a pt, really think about how it may hurt them.
Don't focus on how a procedure might help a pt, really think about how it may hurt them.
D
deleted980918
Another aspect that people don’t like to mention is that doing a PCI on a pt with low life expectancy will ding the operator statistic which is often linked to bonus/promotions/advertisements etc. you can google many hospital advertising their cardiologists have achieved 3 star safety ratings. Many states track PCI outcomes within a certain time frame, a pt dies from metastatic CA in 90 days vs PCI complication in 90 days is the same mortality point to an operator. It’s sad but it’s true.
- Joined
- Dec 21, 2008
- Messages
- 1,677
- Reaction score
- 814
This. While catheterization tends to be a low-risk procedure, when things go wrong, they can really go wrong in a number of bad ways.
Also, as was mentioned, PCI metrics are often based on morbidity/mortality within a certain number of days post-procedure. Doesn't matter if the patient walks out of the hospital and promptly takes a shotgun blast to the chest; if within a certain number of days from PCI, it will still count as a cath lab mortality.
Last edited:
- Joined
- Jul 27, 2013
- Messages
- 38,531
- Reaction score
- 75,635
Bad outcomes for very little reward
D
deleted480308
Risk vs reward
Complications tend to be higher in older patients, more likely to perforate older coronary arteries during procedure, need for dialysis due to contrast, groin site complications, issues with delirium, aspiration and hypotension from sedation, inability to take PO antiplatelets if severe dementia, etc. for minimal benefits.
Always have to ask yourself are you prolonging life or are you prolonging death?
Always have to ask yourself are you prolonging life or are you prolonging death?
Last edited:
D
deleted480308
Beyond sugical risk there is a little bit of socialized resource utilization tied up in this too.
- Joined
- Apr 28, 2006
- Messages
- 6,133
- Reaction score
- 2,367
We should also start cathing people on hospice.
Why not start cathing corpses too?
Show me a trial which shows benefit to cathing someone actively dying of a noncardiac cause and I'll do it. I'd argue that in many of these people we actually would cause more harm than benefit...
And this is from someone aggressive about cathing very sick patients...
- Joined
- Oct 17, 2012
- Messages
- 42
- Reaction score
- 31
Believe it or not, and despite what you might have heard or read in the newspaper, for the most part cardiologists/interventional cardiologists are doctors first, and they do what is the right thing for the patient. Often that means letting nature take its course. Stents have their uses but they don’t cure dementia or metastatic cancer.
