That research project alone may have altered the clinical practice of many cardiologists, says Fonarow, a member of the steering committee for the American Heart Association's Get with the Guidelines program.
"This made either approach comparable, but obviously, the medication approach being less expensive and less invasive would be the preferable strategy for managing patients," Fonarow says. "And that has had an influence on some of the management approaches that have been utilized for many physicians."
The shift, however, has been modest, he emphasizes. "There are still some people who think there are still too many procedures being done in stable coronary disease patients, while others believe that it's corrected itself. But as with any medical or surgical circumstance, there's practice variation at different rates as you look across the country."
A few years later, a second development may have prompted some more aggressive cardiologists to get the message if they hadn't already done so.
Major federal investigations in at least five states resulted in accusations against at least seven cardiologists that they performed unnecessary coronary intervention procedures on patients who didn't need them in a fraudulent effort to bilk payers, especially Medicare.