The Pen is Mightier than the Sword

Medical management or surgical intervention?  For some conditions, it's clear cut.  In diabetes, the surgeons don't have much of a role (unless you consider bariatric surgery).  Same with hypertension (unless you're looking at renal artery stenosis or pheochromocytoma).  The shoe's on the other foot when it comes to appendicitis (although there are some folks considering antibiotics alone).  In the middle is heart disease.  Over the last few years, we started to look more closely at medical management.

Just last week, a study was published in the New England Journal of Medicine that concluded that medical management was equivalent to coronary artery bypass grafting for ischemic heart failure with regards to all-cause mortality.  Granted those who underwent a CABG had a slightly lower risk of cardiovascular death.  But when you think about it, we have to die from something at some time, so all-cause mortality is key.

How did they come to this conclusion?  In the international study, STICH, they followed 1,212 men w/heart disease (specifically coronary artery disease amenable to CABG) and heart failure <30% ejection fraction.  But what does this tell us about the mortality risk for those with heart failure but without ischemic disease.  Nothing.  For now, it's imperative that we offer standard of care medical management when it comes to treating those with heart failure, regardless of the type chosen.