Just as the science of jet aircraft advanced to break the sound barrier, a new Texas law has broken the "Insurance Barrier" to providing heart scans for asymptomatic patients at risk for heart disease. The primary supporting evidence was provided by the SHAPE Guidelines (full report).
The bill was introduced by an asymptomatic Texas legislator who first discovered he had life threatening heart disease after a heart scan. Armed with this firsthand knowledge he submitted a bill his first day back from heart bypass surgery. The Governor of Texas recently signed the bill into law that now mandates coverage. The only pity is that, had the Texas legislator had a heart scan years earlier and undergone an intensive prevention program he may have been spared the cost and pain of heart surgery.
Most encouraging is that fact that the move was supported by the American College of Cardiology (ACC), the first such traditional professional society to do so. Predictably, the stodgy and co-opted American Heart Association (AHA) remained silent. It is no secret that the AHA has a vested interest in maintaining the status quo. If heart disease is cured who needs the AHA? This is the same organization that promotes foods like "Cocoa Puffs" as "heart healthy." It is also no surprise they charge companies for their heart healthy designation.
The AHA cover for their objections is an old and tired cost/benefit argument. An AHA spokesperson offered, "From the AHA's perspective, our science is still demonstrating a limited return on investment, and we encourage patients to visit with their physicians and discuss all the options available to them that are most appropriate for their given situation. . . . AHA prides itself in using science to determine the positions we take on pieces of legislation, and the science just isn't there yet for determining the how or why on mass screening." This is, in a word, baloney!
Yes, if you factor in only the upfront cost of a heart scan for the covered population of asymptomatic heart disease sufferers the cost can seem high. However, a while back I took part in a comprehensive analysis of the costs of the traditional "crash and repair" approach to heart disease (wait for chest pain or heart attack) versus the costs of "preventive screening" approach. My job as an MBA and statistician was to work with a cardiologist to develop a method of calculating the cost difference based on a range of variables. The costs savings for prevention was in the billions. (You can enter in your own assumptions and run the calculations for yourself at this web address.)
Another objection offered was the cost of treatment for false positives. This is a clear indication of pure ignorance which respect to coronary calcium scoring as one of the screening modalities. If you have a calcium score greater than zero you have heart disease to some degree. False positives are extremely rare. It may not be life threatening at the moment but this is exactly when you want to know. Like cancer, heart disease is most treatable in its early stages.
The final objections were that there were no sufficiently powered studies to prove that early screening actually saved lives and that doctors would not know what to do with the results. Cardiac calcium scoring measures the presence of the disease itself and is NOT just another risk measure to determine if you MIGHT have heart disease. Let me repeat this, if you have a non-zero calcium score you almost certainly have some level of heart disease. What idiot would argue that if you found cancer in your body you would need a "sufficiently powered" study to support the fact that cancer will advance to a life-threatening stage?
Finally, the fact that doctors may not know what to do with the results is an indictment of the doctors and traditional medicine itself rather than an argument against heart scans. This attitude is perhaps the most frightening of all and another reason we should all engage in informed, self-directed healthcare.
Looking out for your heart health,
Published On: June 24, 2009