1 in 5 Coronary Stents Placed Unnecessarily in Medicare Patients at $2.44 Billion Cost: Report

Between 2019 and 2022, one unnecessary stent procedure was done every seven minutes.

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One in five coronary stent procedures done in the United States under Medicare are unnecessary and cost taxpayers around $800 million a year, revealed a recent report.

A coronary stent is a tiny tube inserted into a blocked heart artery to widen it so that blood can easily flow through. Between 2019 and 2021, U.S. hospitals performed more than 229,000 unnecessary coronary stent procedures at a rate of one per seven minutes, according to an Oct. 31 report from think tank Lown Institute. It estimated that one in five stents were placed unnecessarily in Medicare patients at a cost of $2.44 billion, which comes to roughly $800 million a year.

Out of the 1 million stents placed by hospitals, 22 percent met the criteria for overuse. The rates of stent overuse varied across hospitals, with some facilities registering over 50 percent overuse.

“When physicians continue a practice despite the evidence against it, it becomes more dangerous than useful,” said Dr. Vikas Saini, a cardiologist and president of the Lown Institute, according to an Oct. 31 press release. “The overuse of stents is incredibly wasteful and puts hundreds of thousands of patients in harm’s way.”

“The frequency at which stents are overused shows that many physicians are struggling to keep up with the evidence. To be socially responsible, hospitals need to take a more active role in reducing these unnecessary procedures.”

Between 2019 and 2021, the hospital with the highest rate of coronary stent overuse was Amarillo-based Northwest Texas Hospital, which had an overuse rate of 52.58 percent.

Riverview Regional Medical Center, Alabama, came in second at 50 percent, followed by Kansas Medical Center, Kansas, with 48.88 percent, UW Medical Center-Montlake, Washington, with 46.18 percent, and Riverside Medical Center, Illinois, with 45.79 percent.

The hospital with the lowest rate of stent overuse during the period was Magnolia Regional Health Center, Mississippi, at just 1.24 percent.

Kaiser Permanente San Francisco Medical Center, California, came in second with 1.58 percent; followed by Kaiser Permanente Santa Clara Medical Center, California, with 3.71 percent; HCA Florida Northwest Hospital, Florida, with 3.89 percent; and Strong Memorial Hospital, New York, with 5.41 percent.

For the analysis, the Lown Institute examined stent procedure data from 1,773 hospitals. It used Medicare’s pre-procedure cost of $10,615 for low-value stents in its calculations. Out of the $10,615, Medicare pays $9,015, while the remaining $1,600 is paid by beneficiaries.

Unnecessary Procedure

The Lown Institute also questions the necessity of coronary stents, pointing out that “years of research shows that stents for stable heart disease provide no benefit over optimal medication therapy,” according to the release.

An October 2022 study published in the New England Journal of Medicine found that using stents for treating heart failure may be unnecessary.

Among the 700 patients who took part in the study, half of them randomly received stents while the remaining half received standard heart failure treatments. These patients were tracked for eight years.

An average of 3.4 years after receiving treatments, patients who received stents were found to be just as likely as those who did not get it to be admitted to hospital or die from heart failure. Blood tests and heart scans did not show any difference in the pumping strength of the heart.

Patients with stents had a better quality of life in the first year. But this difference disappeared after the second year.

In an interview with Lown Institute back in 2017, David Brown, a professor of medicine at Washington University of St. Louis, pointed to several reasons why stents are being used despite growing evidence against them.

“For many, I think it’s an open mind. I won’t get into financial conflicts of interest, which are an issue as well, but more important is a lack of intellectual openness,” he said.

“It’s hard to think that the procedure we were trained to do for so many years doesn’t actually help patients. But if cardiologists look at the evidence objectively and with an open mind, that should be all it takes for them to make changes in how they talk to patients about the issue.”

He pointed out that the decision on whether or not to put a stent is not a life or death issue and is instead a lifestyle issue. As such, it must be patients who “should be making the decision after they are informed of all the benefits and risks.”

Pros and Cons

While ensuring better blood flow through the artery, stents can also improve symptoms like shortness of breath and chest pain. They can prevent the artery from becoming too narrow again.

Doctors may advise stents when a patient has suffered a heart attack or if they suffer from atherosclerosis, a condition in which plaque collects inside the artery.

Stents can also be harmful. A July 2023 study found that “unplanned coronary dissection” or tearing of the coronary artery occurred in 1.4 percent of participants who received stents.

“Most target vessels were significantly diseased: 48 percent had moderate/severe tortuosity and 62 percent had moderate/severe calcification.” Coronary artery dissection could lead to “adverse clinical outcomes,” including death, it stated.

Other potential risks include stent thrombosis or blood clots and stent embolization in which the stent gets dislodged, both of which come with the risk of heart attack or death.