Conflicts of Interest in the Management of Silent Ischemia

Abstract

Nonclinical factors that may pressure physicians to intervene when a patient presents with so-called silent ischemia, and that may compel a management course not necessarily in the patient's best interest, are explored. These factors include the public's "obsession" with cardiac health, the enormous potential market for pharmaceuticals and medical devices, the funding of ischemia research by drug and medical device companies, the growth of "interventional cardiology" as a subspecialty, the increasingly entrepreneurial approach to medical care on the part of physicians and hospitals, and the fear of malpractice litigation. Given the financial advantage to health facilities and practitioners in recommending an interventionist rather than a conservative approach to silent ischemia, Graboys questions whether studies to determine the optimal management of this condition will ever be undertaken.