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May 29, 2007
more on hogberg
More on Hogberg's measures: He goes further than the OECD, narrowing in on a few measures that meet his (admittedly better) criteria. He uses the GUSTO 1 trial in its 5 year extension, to illustrate a good measure.
But GUSTO showed a decrease in mortality at 5 years from 21.4 to 19.6 % (Canada to US). So 1/50 less die in the US than in Canada. This benefit is supposedly from the 43% who received stent or CABG in the US, versus the 15% in Canada. So out of a 1000 people with a heart attack, 196 in the US will be dead in 5 years, and 214 in Canada. But 436 of the US 1000 will have had a major intervention, and only 154 of the Canadians. So "fix" 280 more, and 18 more will do better. GUSTO only proves what every other study on coronary disease intervention proves - no meaningful benefit to intervention.
The COURAGE (Clinical Outcomes Utilizing Revascularization and AGgressive drug Evaluation) concluded that more honestly for people with stable coronary disease. There is NO benefit in mortality to invasive intervention (stent or CABG) and minimal and limited benefit symptomatically. Same with the OAT (Occluded Artery Trial).
| By Robert Maddox | 07:42 PM