Public apprehension over unnecessary medical procedures should not delay treatment, say cardiologists in Keralam

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The Interventional Cardiology Council of Kerala (ICCK) has said that public apprehension over unnecessary medical procedures should not delay treatment during a heart attack, pointing out that hesitation in an emergency can cost precious time.

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

“At the same time, it is important to distinguish an emergency angioplasty performed during an acute heart attack from a planned or elective procedure. When an artery supplying the heart is suddenly blocked, restoring blood flow at the earliest can save heart muscle and, in many cases, save the patient’s life as well,” ICCK president T. Rajesh said. He said that public discussion on angioplasty should therefore clearly differentiate between elective intervention in stable patients and primary angioplasty during an acute heart attack, where treatment is highly time-sensitive.

According to the State-wide ICCK registry data, more than 70% of the angioplasties performed in Keralam involved acute and emergency clinical situations. “This is important when looking at the overall number of angioplasties in the State. A substantial proportion involves patients arriving with heart attacks or other acute coronary conditions where decisions have to be taken within a narrow treatment window,” Dr. Rajesh said.

Modern cardiology, he said, has moved towards increasingly precise and objective assessment before an intervention is undertaken. Clinical examination, ECG findings, cardiac biomarkers, coronary imaging and, wherever necessary, advanced techniques to assess the functional significance of an arterial narrowing help doctors identify patients who are most likely to benefit from intervention. “When patients report early, the treating team has the opportunity to establish the diagnosis, assess the severity of the condition and choose the most appropriate treatment before the critical window is lost,” he said.

Dr. Rajesh said the focus should therefore not be on the number of angioplasties in isolation, but on whether they are clinically indicated and whether patients who need emergency restoration of blood flow receive it in time. “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, a delay can have serious consequences,” he said.

The ICCK functionaries said advances in physiological assessment and intravascular imaging had further strengthened the ability of cardiologists to evaluate coronary blockages and tailor treatment to individual patients.

The council, meanwhile, 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.

ICCK general secretary Louie Fischer said apprehension about investigations or angioplasty should never deter a patient from seeking immediate medical attention. “Our concern is that patients should receive appropriate treatment without unnecessary anxiety or dangerous delay. Modern cardiac care gives physicians increasingly sophisticated tools to make precise treatment decisions, but those decisions can help only if patients reach the hospital in time,” he said.

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