PET: COURAGE on a bike

The PET presentation was fascinating but I left a bit sad.

It’s sad because we can ride a bike for 50 minutes per day and control angina and events better than turning our coronaries into Slinkies.  Incredibly, patients rarely choose angiogenesis over plumbing.  Even worse, they don’t choose it because physicians rarely offer it.

I’m not talking about ACS here.  I’m talking about stable angina patients; those that take a nitro when they over -do; those that flunk an outpatient stress exam; those at the highest risk of getting a PCI, i.e. getting a cath prior to a functional assessment.  

I'm not a victim of an alien invasion.  No one put a pod in my bedroom.  I’m still the same person that champions a timely PCI for STEMI the world over.  I still believe a wire coil is the superior therapy for patients who flunk medications or can’t or won’t take them, except those with high Syntax scores who need a CABG.  I’m incensed with the “cathing for dollars” MOA. I insist that the greatest majority of cardiologists aren’t guilty of that,  but for those who are--you'd better watch your back.  Managed care is coming and it should be coming for you.  

 The expense for the PCI route is exhaustive.  It includes admit costs, procedure costs, physician costs (in the US). Though Clopidogrel will go off patent soon, waiting in the wings is Prasugrel or Ticagrelor which won’t be cheap I assure you.  Further costs include a  repeat procedure in 2 years,  a repeat procedure in 3 years, bypass surgery in 8 years (because we became  fat without the tools for lifestyle modification). We must purchase  diabetic medication (because we remain fat), have more procedures (because we are even more fat), plus still need to purchase  standard medications .

 I’m not an accountant, but I do accept that most things can be written in easy mathematical terms that our patients can understand and implement:  

Lower cost longevity =  [(the cost of Fresh fruits and vegetables) + (the cost of a bike + meds)] < [(sloth x poor eating habits) + (a lifetime of procedures + meds)].

Every angina patient should be given this formula for success and the PET trial cohorts received just that.  We will doom our patients to failure without it.  

The lifetime expenditure for a PCI recommendation without lifestyle modification often amounts to hundreds of thousands of health care dollar expenditures per life time.  

The expense of angina control with lifestyle change:  $350.00 for Schwinn Air dyne, $400.00 for a decent outdoor bike,  $30.00 for a  helmet, $.89 cents for a bottle of water. (That's around $780.89 US)

The expense of prevention? Even less.   

Living longer for less money and with less hassle by giving our patients enough COURAGE to hop on a bike:     Priceless.

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