New technologies have shown that in around thirty percent of patients cardiac stents are entirely unnecessary, according to cardiologist Dr Ramesh Babu Pothineni, the managing director of Ramesh Hospitals Group.
Cardiac stents have been a matter of contention in recent years in India, primarily due to them being the focal point over the capping of the prices of some medications and medical devices by the central government. The move to cap the price of cardiac stents came following the release of data by the National Pharmaceutical Pricing Authority (NPPA) revealing that profit margins from the manufacturer to the patient were as high as 1000 percent.
As many Indians were paying out-of-pocket for these procedures, the often life-saving surgery was coming at a considerable cost, leaving many struggling with debt following the procedure. Price margins were elevated at each stage of the supply chain, with suppliers increasing price compared to the purchase price from manufacturers, and likewise, hospitals increasing the cost to the patient compared to purchase price from suppliers. Many of these patients could soon see their medical bills reduced if a practice known as “deferred stenting” is adopted.
Traditionally, stents were used in any instance of blood vessel blockage, from severe — often complete — cases of blockage to more moderate disruptions of blood flow. “We found that deferring the implant of stents for a few hours or even days helped better outcomes as it gives time for microvasculature to recover,” Dr Ramesh explains.
Effectively, by keeping a patient under close examination, and ensuring a supply of blood to areas cut off, many individuals were able to restore blood flow without the need for the implantation of a cardiac stent. Dr Ramesh notes that in many cases, such as in a severe heart attack in which blood flow is entirely cut off, a cardiac stent is indeed a necessity. However, using more advanced scanning techniques such as doppler sensors has allowed a more in-depth examination of the situation within the blood vessels, giving the opportunity for a more informed decision making process in regards to implanting a stent.
Cardiac disease is India’s leading cause of death, responsible for 28.1 percent of all deaths in the country in 2016 and being among the most prevalent conditions. As such, any development that can improve surgical outcomes for cardiac disease, or make the process more cost-effective, is a welcome benefit.