Questions raised over use of heart test
Resources better spent in other ways, say doctors who contributed to George Lee’s RTÉ documentary
George Lee’s recent RTÉ documentary on heart disease has been criticised by two Irish cardiologists who contributed to the programme.
Broadcast earlier this month, The Heart of the Matter was, as its title indicated, an examination of cardiovascular disease, “Ireland’s biggest killer”.
However, its focus on the role of CT scanning in identifying those most of risk of the disease has proved contentious, even with experts who appeared on the one-hour documentary.
Every day more than 10 lives are lost in Ireland as a result of a sudden heart attack. “It is clear that many of us walk around, unaware that there is a time-bomb ticking in our chests,” the promotional material dramatically proclaimed.
But according to Lee, a new test was available to stop these deaths and save “countless lives. This film could change your life, it could save your life,” he announced to viewers at the beginning of the programme.
A simple “calcification test” could tell people if they have heart disease, the programme asserted. The test takes the form of a CT scan to assess the build-up of fatty plaque in the coronary arteries.
Central to the story is David Bobbett, an Irish entrepreneur who has made millions selling kitchens to fast-food chains. In 2011, he discovered through a routine medical that his odds of suffering a heart attack were very high, despite a fit lifestyle and healthy diet.
“It was only when I embarked on a personal journey of research and discovery that I learned that I was a 52 year old with the heart of an 87 year old, and was at serious risk of a heart attack,” says Bobbett.
“The test saved my life. By diagnosing my heart disease, I was able to readjust my lifestyle to significantly slow the disease progressing. Had I known about this test when having my annual medical check-ups in Ireland, I could have prevented my disease from progressing.”
Bobbett is on a mission to tell the world there is a better way of identifying heart disease. The programme was based on his idea and supported by his company, H&K International, and the charity he has recently established, the Irish Heart Disease Association.
The documentary relied heavily on the input of American heart experts but in Ireland their colleagues are far from convinced about his thesis.
Ian Graham, professor of cardiovascular medicine at Trinity College, accuses it of showing “an appalling lack of balance” – despite the fact that he appeared in the programme. “The test is neither new nor revolutionary and there is a real danger that resources may be diverted from the vastly larger numbers who need much cheaper and easier risk assessment.”
Graham says he explained the issues in great detail but this was edited out. He believed a decision had clearly been made to aim for drama and not balance.
Dr Angie Brown, medical director of the Irish Heart Foundation, also appeared in the documentary but claims it was misleading.
She says calcium scoring can be useful as a diagnostic test and is used to guide medical management for those at intermediate risk. “A normal calcium score does not preclude the individual from having a heart attack or stroke and if that individual has other significant risk factors they should still have those risk factors addressed.”
The test is relatively expensive and has a radiation dose associated with it both of which make it unsuitable for widespread use, she adds. “With limited resources, we need to look at the cost benefit of everything we do and make sure what we do is available to all as appropriate.”
“If everyone knew their numbers – blood pressure, cholesterol, weight, etc – it would yield greater benefit for heart disease prevention than this test,” Graham argues.
Bobbett maintains the test is ideally suited to alerting people with medium risk – for example, someone with no obvious symptoms but with a family history of heart disease – to the dangers they face.
He believes people are far more likely to live healthily if they are aware they are in a high-risk category.
Yesterday he responded to the arguments made by the two cardiologists. “Calcification testing tells you whether you have heart disease or not. Its purpose is not to identify vulnerable plaques, but to identify vulnerable patients.”
He says people should be really concerned that the test has not been made available in Ireland. “This costs less than having your car serviced, and it’s a one-off.”
“The radiation from a calcification test is about the same as that of a mammogram, or the radiation exposure from a flight from Dublin to New York,” he says.
As for the allegation of lack of balance, he says the purpose of the programme was to educate the public that the test is the best predictor of future heart attack. Once identified, the disease is treatable.
A spokesman for the documentary makers said: “Loosehorse took great care in making the documentary to present expert opinions on both sides of the debate and we take our responsibilities of balance very seriously. The programme reached over half a million people and was intended to be thought provoking and engaging, given the complexity of the topic concerned. We feel that this level of public engagement with cardiovascular disease is a very positive thing and we are happy to stand over the programme.”
Whatever about the arguments and counter-arguments, Lee’s primetime performance struck a chord with viewers and in the days that followed the phone lines of the Irish Heart Foundation were busy with calls from worried patients wondering if they should get tested.
If they do, the real winners will be the private clinics that offer the test in Ireland, at a cost of up to €400.