In the next 24 hours, nearly 10,000 heart procedures will be performed in hospitals across the U.S. That's 365 days a year, year after year.

Procedures and drugs taking aim at heart disease appear to be getting better and better-yet the cardiovascular healthcare system grows bigger, generating more procedures, more expensive pharmaceutical agents, costly new devices. A day doesn't go by that most of us aren't assaulted with several TV ads, radio spots, billboards, and news reports of hospital heart care.

The cardiovascular healthcare system in the U.S. has mushroomed into a gargantuan industry. The American Heart Association estimates that over $313.8 billion will be spent in the U.S. on cardiovascular healthcare in 2009 (American Heart Association, Heart Disease and Stroke Statistics-2009 Update). The U.S. Department of Health and Human Services projects that total health care spending will double to $3.6 trillion by 2014, consuming 18.7 percent of the nation's economy. Cardiovascular care is the largest piece of the total healthcare bill. The system grows, pulling more and more Americans into this hungry procedure generating process that maintains an insatiable appetite for more.

Just what are we getting for our $318 billion? How much of it is truly necessary or beneficial to us? How much is performed for the benefit of the doctor or hospital?

Hospital heart procedures - What is accomplished?

Hospital heart procedures like balloon angioplasty, stent implantation, atherectomy, coronary bypass surgery¾all the procedures for coronary disease - restore coronary flow when flow is reduced.

Quite simply, during heart catheterization (the starting point for all major heart procedures) access into the artery system is gained through the leg (femoral) or arm (brachial or radial) artery, pre-formed catheters passed through the aorta and to the heart. Catheters are used to both inject x-ray dye as well as pass equipment, such as wires that act as a "rail" system to pass balloons, stents, cutting devices, and other tools for dealing with the various configurations of atherosclerotic plaque in arteries.

If the anatomy is unsuitable for angioplasty and related procedures (e.g., blockage located at a difficult branch point, or involvement of the left mainstem, a potentially hazardous area for stents) then bypass surgery might be considered. In this case, the mammary artery from within the chest wall or a leg vein is "harvested" and used as an alternative conduit for blood flow.       

In other words, if there is a 70% blockage or more and there is evidence for poor blood flow to that segment of the heart muscle (suggested by symptoms like chest pain or breathlessness), an abnormal stress test showing poor flow to one or more segments of the heart, or an area of abnormally reduced strength of the heart muscle (e.g., on an echocardiogram), then there is potential benefit to restoring poor blood flow by expanding a rigid stent that scaffolds the artery open. This is because poor blood flow to the heart can be dangerous and trigger unstable heart rhythms.