Coronary artery bypass graft does carry risks

Fiona Kirkwood, British Heart Foundation

They suggested a rating system to identify patients who would benefit most from bypass surgery may be a better alternative.

Using official figures, Professor Stephen Frankel and colleagues calculated that between 280 and 330 people die while waiting for bypass surgery on the NHS in England every year.

Death rates

They also calculated that between 285 and 390 people die every year within six months of undergoing the procedure.

The authors said the figures suggested doctors should not refer every patient for heart surgery. They said patients' quality of life and future prognosis should be taken into account.

But they acknowledged that such a policy would have to be explained to the public.

They said: "The use of expert ratings of appropriateness, which are a reflection of net expected benefit and harm, and which have been validated against clinical outcomes, offer a more appropriate routine decision making tool in improving the quality of care than the current focus on waiting list targets."

They added: "This study does not condone the existence of waiting lists.

"However, it suggests that a more balanced portrayal of the true risks of operative treatment will be important in developing a greater public understanding of the relative merits of prevention, medical management, and surgical measures in the reduction of the morbidity and mortality attributable to coronary heart disease."

Risks

Fiona Kirkwood, medical spokesperson at the British Heart Foundation, said: "The research highlights that coronary artery bypass graft does carry risks and that prevention and medical management of angina and coronary heart disease are also important.

"When people have coronary bypass graft or are waiting there are many social and psychological implications.

"Steps have now been put in place by the government to help reduce waiting times but in the meantime we need to ensure that communication between GPs and surgical teams will support those who are waiting or recovering from coronary artery bypass graft."