ChangeWave Research: Cardiac Care – Trends in Diagnosis & Treatment
ChangeWave Research Report:
Cardiac Care – Trends in Diagnosis & Treatment
Overview
During the week of March 22-26, 2007, we surveyed Alliance healthcare industry members on trends in cardiac care – including heart disease and related issues. A total of 103 doctors participated.
In early April we alsoconducted a follow-up survey,asking 65 of the same doctors aboutthe effects of a recently published studyon stent usage.
Bottom Line: Our March survey results showed an increase in the number of both early and late stage heart disease patients over the previous 12 months.
In terms of diagnostic methods, Electrocardiogram and Echocardiogram were the most utilizedheart disease testsover the past year. But BNP/NT-proBNP andC-reactive Protein (CRP) Blood Tests appear to have the most momentum going forward.
Focusing on treatments, ‘Medication’in general is the heart treatment category that has experienced the biggest increase – with ACE Inhibitors reported as the most prescribed medication for heart disease, followed by Beta Blockers and Anti-Platelet Medications. Looking forward, doctors think ACE Inhibitors and Anti-Platelet prescriptions will increase most over the next 12 months.
A Look at Stents
Recent medical results (the COURAGE study) - published in the New England Journal of Medicine - called into question the benefits of stent usage for some patients.
To measure the true impact the COURAGE results are having on doctors, we conducted a survey on stents immediately before and after the trial findings. Here's what we found:
- Usage of Stents– Next 12 Months. In our initial survey (March 22-26; before the COURAGE trial results were published), 22% of doctors thought Drug-Eluting Stents would experience the largest increase in usage in their practice over the next 12 months, while 15% thought it would be Bare-Metal Stents.
In our follow-up survey (April 5-9; after the COURAGE trial results were published), only 11% thought Drug-Eluting Stent usage would experience the largest increase in their practice over the next 12 months, and 9% thought it would be Bare-Metal Stents.
Other Key Findings from our April 5-9Follow-up Survey:
- Doctor Willingness to Recommend Stents. Within their own practice, 36% of doctors see a decrease in willingness to recommend Bare-Metal Stents due to the COURAGE trial results, and 29% see a decrease in willingness to recommend Drug-Eluting Stents.
- Patient Willingness to Undergo Stent Procedures. A total of 54% say there will now be a Decrease in patient willingness to undergo a stent procedure (8% Significant Decrease, 11% Moderate Decrease, and 35% Slight Decrease).
Summary of Key Findings
The ChangeWave Alliance is a group of 10,000 highly qualified business, technology & medical professionals in leading companies
of select industries—credentialed professionals who spend their everyday lives working on the frontline of technological change. ChangeWave surveys its Alliance members on a range of business and investment research and intelligence topics, collects feedback from them electronically, and converts the information into proprietary quantitative and qualitative reports.
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Table of Contents
Summary of Key Findings...... 2
The Findings...... 4
(A) Heart Disease Diagnosis...... 4
(B) Heart Disease Treatments...... 7
(C) Stents and Implantable Cardiac Defibrillators...... 8
ChangeWave Research Methodology...... 16
About ChangeWave Research...... 17
I. The Findings
Introduction
During the week of March 22-26, 2007, we surveyed Alliance healthcare industry members on trends in cardiac care – including heart disease and related issues. A total of 103 doctors participated.
In early April we also conducted a follow-up survey, asking 65 of the same doctors about the effects of a recently published study on stent usage.
(A) Heart DiseaseDiagnosis
Doctors (n = 103)
(1) Question Asked: How would you characterize the number of early stage heart disease patients within your practice/work environment over the past 12 months? Would you say the number has increased, decreased, or remained the same?
DoctorsThe number of early stage heart disease patients has increased over the past 12 months / 37%
The number of early stage heart disease patients has decreased over the past 12 months / 6%
The number of early stage heart disease patients has remained the same / 39%
Don't Know/NA / 19%
Increased Number of Early Stage Heart Disease Patients. A total of 37% of doctors say the number of early stage heart disease patients within their practice has increased over the past 12 months, compared to 6% who say the number decreased.
(1A) Question Asked: What about late stage heart disease patients? Would you say the number of late stage heart disease patients within your practice/work environment has increased, decreased, or remained the same over the past 12 months?
DoctorsThe number of late stage heart disease patients has increased over the past 12 months / 42%
The number of late stage heart disease patients has decreased over the past 12 months / 8%
The number of late stage heart disease patients has remained the same / 36%
Don't Know/NA / 15%
Late Stage Heart Disease Patients. Additionally, 42% of doctors say the number of late stage heart disease patients within their practice has increased over the past 12 months, compared to 8% who say the number decreased.
(2) Question Asked: There are numerous ways to diagnose Heart Disease. Over the past 12 months, which of the following diagnostic methods – if any – have you or other members in your practice/work environment administered or recommended for heart disease? (Check All That Apply)
DoctorsElectrocardiogram (EKG or ECG) / 84%
Echocardiogram (Echo) / 81%
Holter Monitor / 70%
Stress Test (Exercise EKG) / 69%
Cardiac Catheterization / 65%
Coronary Arteriogram (or Angiogram) / 60%
Angiography / 50%
C-reactive Protein (CRP) Blood Tests / 49%
BNP or NT-proBNP / 48%
Transesophageal Echocardiogram (TEE) / 41%
Radionuclide Studies (including exercise thallium scintigraphy) / 37%
Electrophysiology Studies (EPS) / 30%
Myocardial Perfusion Scans (or SPECT imaging) / 30%
Event Recorder / 30%
MUltiple Gated Acquisition (MUGA) Scan (or Radionuclide Ventriculography) / 27%
Magnetic Resonance Angiography (MRA) / 22%
Cardiac Magnetic Resonance Imaging (Cardiac MRI) / 21%
Tilt Table Test / 18%
Multi-Detector Computed Tomography (MDCT) / 17%
Electron Beam Computed Tomography (EBCT or Ultrafast CT) / 14%
Radionuclide Angiography (RNA) Scans / 11%
Positron Emission Tomography (PET) Scan / 10%
Intravascular Ultrasound (IVUS)/Intravascular Echocardiography / 7%
Signal-Average EKG / 6%
Top Diagnostic Methods – Past 12 Months. Electrocardiogram (84%) and Echocardiogram (81%) are the heart disease diagnostic methods most used over the past 12 months.
(2A) Question Asked: Over the next 12 months, do you think you and/or other members in your practice/work environment are more likely or less likely to administer or recommend the following heart disease diagnostic methods compared to the previous 12 months?
Doctors Net Score:More Likely vs. Less Likely – Next 12 Months
MoreLikely / Less
Likely / Net
Score
BNP or NT-proBNP / 33% / 3% / +30
C-reactive Protein (CRP) Blood Tests / 30% / 5% / +25
Echocardiogram (Echo) / 27% / 4% / +23
Cardiac Magnetic Resonance Imaging (Cardiac MRI) / 27% / 5% / +22
Electrocardiogram (EKG or ECG) / 23% / 1% / +22
Event Recorder / 17% / 1% / +16
Multi-Detector Computed Tomography (MDCT) / 20% / 5% / +15
Stress Test (Exercise EKG) / 19% / 4% / +15
Holter Monitor / 17% / 3% / +14
Magnetic Resonance Angiography (MRA) / 21% / 8% / +13
Radionuclide Studies (including exercise thallium scintigraphy) / 18% / 7% / +11
Coronary Arteriogram (or Angiogram) / 17% / 7% / +10
Cardiac Catheterization / 15% / 5% / +10
Electrophysiology Studies (EPS) / 15% / 5% / +10
Myocardial Perfusion Scans (or SPECT imaging) / 16% / 8% / +8
Electron Beam Computed Tomography (EBCT or Ultrafast CT) / 17% / 10% / +7
Positron Emission Tomography (PET) Scan / 13% / 6% / +7
Transesophageal Echocardiogram (TEE) / 11% / 6% / +5
Angiography / 14% / 10% / +4
Intravascular Ultrasound (IVUS)/Intravascular Echocardiography / 10% / 7% / +3
MUltiple Gated Acquisition (MUGA) Scan (or Radionuclide Ventriculography) / 8% / 6% / +2
Signal-Average EKG / 4% / 5% / -1
Tilt Table Test / 5% / 9% / -4
Radionuclide Angiography (RNA) Scans / 4% / 9% / -5
Diagnostic Methods With Momentum. Over the next 12 months, BNP/NT-proBNP(Net Difference = +30) is the diagnostic heart disease test with the most momentum, followed by C-reactive Protein (CRP) Blood Tests(+25).
(B) Heart Disease Treatments
(3) Question Asked: Over the past 12 months, which of the following Heart Disease treatment categories experienced the largest increase in usage at your practice/work environment? (Choose No More Than Two)
DoctorsMedication / 48%
Drug-Coated Stents / 30%
Angioplasty / 19%
Implantable Defibrillators, Pacemakers or Other Electrical Devices / 19%
Bare-Metal Stents / 11%
Traditional Open Heart Surgery / 3%
Treatment Usage – Past 12 Month. Doctors say Medication (48%) is the treatment category experiencing the biggest increase in usage over the past 12 months. Drug-Coated Stents (30%) came in second.
(3A) Question Asked: Which of the following types of heart disease and blood pressure medications would you say you and/or your practice/work environment has written the most prescriptions for over the past 12 months? (Choose No More Than Four)
DoctorsACE Inhibitors (Angiotensin Converting Enzyme) / 79%
Beta Blockers / 64%
Anti-Platelet Medications / 50%
Diuretics / 37%
Calcium Channel Blockers / 34%
Anti-Coagulants / 23%
Alpha Adrenergic Blockers / 6%
Vasodilators / 5%
Digitalis Glycosides / 4%
Most Prescribed Heart Disease Medications – Past 12 Months. ACE Inhibitors (79%) is the heart disease/blood pressure medication most prescribed by doctors over the past 12 months, followed by Beta Blockers (64%) and Anti-Platelet Medications (50%).
(3B) Question Asked: Over the next 12 months, do you think the number of prescriptions written for the following heart disease/blood pressure medications will be greater than, less than, or equal to the number written in the previous 12 months at your practice/work environment?
Doctors Net Difference:Greater Than vs. Less Than – Next 12 Months
GreaterThan / Less
Than / Net Difference
ACE Inhibitors (Angiotensin Converting Enzyme) / 47% / 1% / +46
Anti-Platelet Medications / 43% / 2% / +41
Beta Blockers / 34% / 5% / +29
Anti-Coagulants / 22% / 6% / +16
Calcium Channel Blockers / 21% / 11% / +10
Diuretics / 13% / 6% / +7
Vasodilators / 14% / 13% / +1
Alpha Adrenergic Blockers / 8% / 20% / -12
Digitalis Glycosides / 3% / 25% / -22
Next 12 Months – Top Heart Disease Medications. Looking ahead 12 months, Ace Inhibitors is also the top medication that doctors think the number of prescriptions written at their practice will be greater than it was over the past year –47% say the number will be greater, and 1% say less (Net Difference = +46).
Anti-Platelet Medications also look good over the next 12 months – 43% say the number of prescriptions written at their practice will be greater, and 2% say less (+41).
(C) Stents and Implantable Cardiac Defibrillators
I. Initial ChangeWave Survey (March 22-26):
(4) Question Asked: Based on the patients you've seen over the past 12 months in your practice/work environment, do you think overall use of drug-coated stents has increased, decreased or remained the same?
DoctorsDrug-Coated Stent Use Has Increased / 36%
Drug-Coated Stent Use Has Decreased / 17%
Drug-Coated Stent Use Has Remained the Same / 23%
Don't Know/NA / 24%
Drug-Eluting Stents – Past 12 Months. More than twice as many doctors say drug-eluting stent usage has increased (36%) rather than decreased (17%) in the past year.
(5) Question Asked: A new generation of drug-coated stents is in the pipeline which some analysts believe will be safer than current drug-coated stents. What do you think? How likely is it that the next generation of drug-coated stents will prove to be much safer than current drug-coated stents?
DoctorsVery Likely / 10%
Somewhat Likely / 53%
Somewhat Unlikely / 7%
Very Unlikely / 1%
Don't Know/NA / 29%
Next Generation Drug-Eluting Stents. Nearly two-thirds of doctors (63%) think the next generation of drug-coated stents will be much safer than the ones on the market today.
(6) Question Asked: In recent years there have been a series of recalls and safety alerts issued for Implantable Cardiac Defibrillators (ICDs), though the FDA remains confident in their efficacy. Looking at the next 12 months, do you think the use of Implantable Cardiac Defibrillators will increase, decrease or remain the same compared to the previous 12 months?
DoctorsICD Usage Will Increase / 51%
ICD Usage Will Decrease / 8%
ICD Usage Will Remain the Same / 29%
Don't Know/NA / 12%
Implantable Cardiac Defibrillators (ICDs). Despite recalls and safety concerns, 51% of doctors think ICD usage will increase over the next year. Only 8% think it will decrease.
II. ChangeWave Follow-Up Survey (April 5-9):
Recent medical results (the COURAGE study) - published in the New England Journal of Medicine - called into question the benefits of stent usage for some patients.
To measure the true impact the COURAGE results are having on doctors, we conducted a survey on stents immediately before and after the trial findings. Here's what we found:
(7) Question Asked: Which of the following Heart Disease treatment categories do you think will experience the largest increase in usage at your practice/work environment over the next 12 months? (Choose No More Than Two)(n=65)
DoctorsAfter COURAGE Results
Apr 2007 / Doctors
Before
COURAGE Results Mar 2007 / Change
Score
Medication / 55% / 42% / +13
Traditional Open Heart Surgery / 11% / 5% / +6
Angioplasty / 14% / 18% / -4
Implantable Defibrillators, Pacemakers or Other Electrical Devices / 12% / 17% / -5
Bare-Metal Stents / 9% / 15% / -6
Drug-Eluting Stents / 11% / 22% / -11
Usage of Stents– Next 12 Months. In our initial survey (March 22-26; before the COURAGE trial results were published) 22% of doctors thought Drug-Eluting Stents would experience the largest increase in usage in their practice over the next 12 months, 15% thought it would be Bare-Metal Stents.
In our follow-up survey (April 5-9; after the COURAGE trial results were published), only 11% thought Drug-Eluting Stent usage would experience the largest increase in their practice over the next 12 months, and 9% thought it would be Bare-Metal Stents.
(8) Question Asked: Over the next 12 months, which type of stent – if any – do you think will gain market share?(n=65)
DoctorsAfter COURAGE Results
Apr 2007 / Doctors
Before
COURAGE Results Mar 2007 / Change
Score
Neither - Both Will Lose Market Share Over Next 12 Months / 34% / 6% / +28
Drug-Eluting Stents Will Gain Market Share Over Next 12 Months / 32% / 28% / +4
Bare-Metal Stents Will Gain Market Share Over Next 12 Months / 8% / 20% / -12
Both Will Gain Market Share Over Next 12 Months / 5% / 23% / -18
Market Share. We also asked doctors if they thought either type of stent would gain market share in the next year. In the March survey, 28% of doctors said Drug-Eluting stents would gain market share vs. 20% Bare-Metal stents.
But by the April survey there had been a radical shift in opinion – 32% of doctors said Drug-Eluting stents would gain market share, and 8% now said Bare-Metal stents.
(9) Question Asked: Looking at the next 12 months, what is the likelihood that overall drug-eluting stent usage will decline compared to the previous 12 months?(n=65)
DoctorsAfter COURAGE Results
Apr 2007 / Doctors
Before
COURAGE Results Mar 2007 / Change
Score
Very Likely / 6% / 6% / 0
Somewhat Likely / 42% / 38% / +4
Somewhat Unlikely / 31% / 14% / +17
Very Unlikely / 8% / 20% / -12
III. Other key findings from our April 5-9 follow-up survey:
(10) Question Asked: Based on what you are seeing at your own practice/work locale, has the willingness to recommend Bare-Metal stents decreased due to the COURAGE trial results, or has there been no effect?(n=65)
DoctorsAfter COURAGE Results
Apr 2007
Significant Decrease in Willingness to Recommend Bare-Metal Stents / 0%
Moderate Decrease in Willingness to Recommend Bare-Metal Stents / 8%
Slight Decrease in Willingness to Recommend Bare-Metal Stents / 28%
No Effect on Willingness to Recommend Bare-Metal Stents / 34%
Don't Know/NA / 31%
(10A) Question Asked: And based on what you are seeing at your own practice/work environment, has the willingness to recommend Drug-Eluting stents decreased due to the COURAGE trial results, or has there been no effect?(n=65)
DoctorsAfter COURAGE Results
Apr 2007
Significant Decrease in Willingness to Recommend Drug-Eluting Stents / 0%
Moderate Decrease in Willingness to Recommend Drug-Eluting Stents / 6%
Slight Decrease in Willingness to Recommend Drug-Eluting Stents / 23%
No Effect on Willingness to Recommend Drug-Eluting Stents / 42%
Don't Know/NA / 29%
Doctor Willingness to Recommend Stents. Within their own practice, 36% of doctors see a decrease in willingness to recommend Bare-Metal Stents due to the COURAGE trial results, and 29% see a decrease in willingness to recommend Drug-Eluting Stents.
(11) Question Asked: What about patient perceptions? Do you think the COURAGE trial results will have an effect on patient willingness to undergo stent procedures?(n=65)
DoctorsAfter COURAGE Results
Apr 2007
Yes, Significant Decrease in Patient Willingness to Undergo Stent Procedures / 8%
Yes, Moderate Decrease in Patient Willingness to Undergo Stent Procedures / 11%
Yes, Slight Decrease in Patient Willingness to Undergo Stent Procedures / 35%
No Effect on Patient Willingness to Undergo Stent Procedures / 35%
Don't Know/NA / 11%
Patient Willingness to Undergo Stent Procedures. A total of 54% say there will now be a Decrease in patient willingness to undergo a stent procedure (8% Significant Decrease, 11% Moderate Decrease, and 35% Slight Decrease).
(12) Question Asked: Finally, what do you think are the longer-term implications of the COURAGE trial? What changes – if any – will this cause in the cardiac care marketplace?
Long-Term Effects. We also asked about longer-term implications of COURAGE trial on the cardiac care marketplace. While many said the effects would be minimal, CardiologistANS05051 writes, “...the negative press will result in fewer referrals for invasive cardiac procedures...”
Sample of Alliance Member Responses:
- CardiologistANS05051 writes, “COURAGE trial did not tell us cardiologists anything new, rather the negative publicity surrounding the study including the controversial early divulging of study results is new. That being said, the negative press will result in fewer referrals for invasive cardiac procedures due to decreased willingness of patients to undergo procedures and decreased willingness of third-party payers to pony up for the cost of these procedures.”
- CardiologistJGE3402 writes, “No big changes in use of PCI/stents; the problem with BMS vs.