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Drugs Work as Well as Angioplasties

More than half a million people a year with chest pain are getting an unnecessary procedure to unclog their arteries because drugs are just as effective, suggests a study that challenges one common practice in heart care. The stunning results found that angioplasty did not save lives or prevent heart attacks in non-emergency heart patients. An even bigger surprise: Angioplasty gave only slight and temporary relief from chest pain, the main reason it is done.

Dr. William Boden of Buffalo General Hospital in New York led the study. Angioplasty remains the top treatment for people having a heart attack or hospitalized with worsening symptoms. But most angioplasties are done on a non-emergency basis. According to the study, those patients should try drugs first. Then, if that doesn’t help, they can consider angioplasty. Why do angioplasty not help more? It fixes only one blockage at a time whereas drugs affect all the arteries, experts said. The new study shifts the argument from which type of stent to use to whether to do the procedure at all.

In the study, only one-third of the people treated with drugs ultimately needed angioplasty. “You are not putting yourself at risk of death or heart attack if you defer,” and considering the safety worries about heart stents, it may be wise to wait, said Dr. Steven Nissen, a Cleveland Clinic Heart specialist and president of the College of Cardiology. Angioplasty already has lost some popularity because of emerging evidence that popular drug-coated stents can raise the risk of blood clots months later.

“We deliberately chose to enroll a sicker, more symptomatic group” to give angioplasty a good chance to prove itself, Boden said. All were counseled on healthy lifestyles, and half were assigned to get angioplasty. After three years about 70% of each group was free of chest pain. After four and half years, 19% in each group had died or had a heart attack. Neither treatment proved better for subgroups like smokers, diabetics, or older, sicker people. After five years, about 73% of each group was free from chest pain.

The new study should lead to changes in the treatment of patients with stable coronary artery disease, with expected substantial health care savings. Angioplasty costs $30,000 to $40,000. The drugs used in the study are almost all available in generic form. Dr. Maron said people should give the drugs a chance. “Often I think that patients are under the impression that unless they have an angioplasty done, they’re not getting the best of care and are at increased risk of having a heart attack and die,” he said. The study shows that is not true.

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HSA Contribution Limits

Please be aware of the 2016 annual HSA contribution limits listed below.

  • $3,350* - Maximum HSA Annual Contribution Limit (Self-only)
  • $6,650* - Maximum HSA Annual Contribution Limit (Family)
  • $1,000 - HSA Catch-up Contribution Limit
  • $1,300 - Minimum HDHP Annual Deductible (Self-only)
  • $2,600 - Minimum HDHP Annual Deductible (Family)
  • $6,450 - Maximum HDHP Annual Out-of-pocket (Self-only)
  • $12,900 - Maximum HDHP Annual Out-of-pocket (Family)
  • *For purposes of the full contribution rule an employee is treated as being eligible for the entire calendar year as long as he or she is eligible as of December 1 of that calendar year and continues eligibility throughout the following year. However, failure to maintain eligibility during the "testing period" will result in adverse tax consequences (including an additional excise tax). The testing period begins in December of the year in which the employee becomes eligible and ends the last day of December of the following year.

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