The Rise and Fall of Cardiac Revascularization: Therapeutic Evolution and Health Policy in the Late Twentieth Century

Award Year: 2007	Investigator: David Jones	Budget: $189,224	Categories: Evidence-Based Medicine
Abstract: Over the last 15 to 20 years, evidence-based medicine and clinical practice guidelines have been embraced as ways to rationalize medical decisions about how to treat patients. But the results so far have been mixed, as the treatment of coronary artery disease (CAD) demonstrates. Two of the standard treatments for CAD, coronary artery bypass grafting and percutaneous transluminal coronary angioplasty, have been used far more frequently than indicated, with periods of growth and decline not associated with changes in the evidence base on why and when they should be used. David S. Jones, M.D., Ph.D. explores this disconnect between clinical evidence and medical practice. He considers how physicians have responded to competing hypotheses about the causes of CAD, treatment risks and unexpected complications, and evidence of wide disparities in the use of cardiac surgery and angioplasty. His project, The Rise and Fall of Cardiac Revascularization: Therapeutic Evolution and Health Policy in the Late 20th Century, aims to uncover the range of factors that influence clinical decision making in American medicine. Results should increase understanding of the appropriate uses of bypass grafting and angioplasty, as well as newer technologies such as intravascular ultrasound, stents, and possibly even gene therapy.