Keralam Chief Minister V.D. Satheesan’s statement at a recent function about avoiding unnecessary angioplasty seems to have stirred a hornets’ nest with many doctors objecting to the “generalised statement,” while some lone voices pointed out that Mr. Satheesan was 100% right and that unnecessary procedures had become the norm.

In a Facebook post, Rajesh Gopalan Nair, Professor and Head of Cardiology at the Government Medical College Hospital, Kozhikode, had appreciated Mr. Satheesan “for pointing out a truth.” But it set off an avalanche of comments from the doctors and public, with the latter narrating their harrowing experiences in hospitals and appreciating Dr. Rajesh for calling a spade a spade, while many doctors expressed disappointment at Dr. Rajesh’s stand.

All you need to know about: angioplasty 

Dr. Rajesh, however, made it clear in his post that a person coming into the emergency with a suspected heart attack should in no way distrust the doctor, for the situation may call for an immediate angioplasty.

Second opinion

He also explained clearly the situations when one could afford to wait and seek a second opinion, if angioplasty was suggested to a patient. He also cautioned the public against looking at every doctor or hospital with suspicion. Angioplasty should definitely be done when it is clinically indicated and these situations are clearly documented, he said.

Even though much of the medical fraternity expressed their displeasure at the “unsubstantiated” statement of the Chief Minister and the support that unexpectedly seemed to have come from one of their own, Dr. Rajesh refused to be cowed down. He maintained that he stood by his position that some of the angioplasty procedures done in hospitals were indeed not warranted.

On Monday, the Interventional Cardiology Council of Kerala (ICCK) said in a statement here that public’s apprehension over “unnecessary” medical procedures should not delay life-saving treatment during a heart attack emergency.

Responding to the Chief Minister’s remarks on avoiding unnecessary investigations and angioplasty, the council said it supported evidence-based and ethical medical practice and the principle that every intervention must have a clear clinical indication.

ICCK president Rajesh T. said that public discussion on angioplasty should clearly differentiate between elective intervention in stable patients and primary angioplasty during an acute heart attack, where treatment is highly time-sensitive.

What the data show

According to Statewide ICCK registry data presented at the council’s last annual conference, more than 70% of angioplasties performed in Kerala involved acute and emergency clinical situations.

He said the council welcomed any discussion aimed at strengthening evidence-based care, transparency and public confidence in the health-care system. “In stable patients, there is usually greater scope for detailed evaluation and for deciding whether medicines, further assessment or intervention would offer the greatest benefit. In an acute heart attack, however, delay can have serious consequences,” ICCK said.

However, the council cautioned that a general atmosphere of mistrust surrounding cardiac procedures could have unintended consequences, particularly when a patient develops severe chest pain or other symptoms suggestive of a heart attack.