Two sides to every story

Kaitlyn Dmyterko, staff writer

“Every truth has two sides; it is as well to look at both, before we commit ourselves to either,” wrote Aesop, a sixth century Ancient Greek fabulist and author.

Last week, multiple studies outlined the benefits of publicly reporting outcomes for various interventional procedures, including CABG, where only five of the 221 reporting sites fell below the national average, alluding to the fact that public reporting may equate to improved care. But, this week we find contrasting information about the benefits of quality reporting.

A report published in the Annals of Internal Medicine found that making board certifications, physician education and malpractice claims public may still not hand out enough information to patients in helping them become informed about the potential quality of care by individual physicians.

Using claims data from over one million adults, the researchers evaluated over 100 quality measures for more than 10,000 physicians practicing in the state of Massachusetts. Reid and colleagues found overall performance to be recorded at slightly more than 60 percent, demonstrating that there was no direct link between quality of care and malpractice claims filed.

In other news this week, a study published in the Journal of Internal Medicine found that use of the long-standing simplified version of the Framingham risk score test, which uses risk factor valves rather than computerized data, may be a poor predictor of cardiovascular risk.

The researchers reported that more than five million Americans have the potential to be misclassified by the test, 1.8 million at a lower risk for CV then they actually are. However, the Framingham test is still widely being used in practice today to outline an individual's risk of CVD.

Additionally this week, a substudy of the PLATO trial found that ticagrelor (Brilinta, Astra-Zeneca) achieves better antiplatelet effect in the first hours of treatment and in maintenance therapy when compared with clopidogrel (Plavix, Sanofi-Aventis/Bristol-Myers Squibb) in patients with acute coronary syndrome.

Researchers found a small number of patients who were poor responders to tricagrelor, but it was more common that patients were poor responders to clopidogrel.

These new data fuel the debate on whether indications for clopidogrel should change after FDA examined evidence that patients without the CYP2C19 gene may be poor responders to the drug and not receive its full benefits.

While some argue that only 3 to 14 percent of the population are absent the metabolizing gene, other drugs on the market—tricagrelor and prasugrel (Effient, Sanofi-Aventis/Daiichi-Sankyo)—could trump clopidogrel's benefits and also alleviate the need for genetic testing.

Potentially to consider all these data and implications, the FDA extended the review of ticagrelor this week for an additional three months, with Dec. 16 as the new decision date.

Like Aesop quipped, and like every situation in life, there are two sides to every story; however, with research in the medical industry there are often multiple sides of the story. Most weigh the risks and benefits of procedures, devices or drug therapies, and most research either agrees or agrees to disagree; however, physicians, federal agencies and policymakers are left with a tricky decision, leaving them asking themselves: do the benefits outweigh the potential risks?

On these topics, or others please feel free to contact me.

Kaitlyn Dmyterko
Kdmyterko@cardiovascularbusiness.com