Cheney Provides Good Case Study for Cardiologists

Article excerpt

ORLANDO -- At a meeting of the American College of Cardiology in Orlando, the case of Vice President Dick Cheney, now the world's most prominent heart patient, was often used to highlight the vast improvement in cardiac care over recent years.

Leading cardiologists compared the differences in care for Cheney and President Dwight D. Eisenhower after his serious heart attack in 1955 at age 64. Cheney quickly returned to work after two brief hospitalizations since November for a mild heart attack and procedures to open constricted arteries.

During a vacation in Denver, after Eisenhower had complained of chest pains during the night, his doctor ordered Mamie Eisenhower to cuddle up in bed next to her husband, to keep him warm, until he was taken to the hospital in the morning. There doctors treated him with the standard care of the day, which included a combination of drugs, a stay in an oxygen tent and bed rest. Then, doctors had little more to offer Eisenhower because few of the now standard drugs like clot busters existed, and there were no angioplasties, stents, coronary care units, defibrillators, pacemakers, ultrasound or bypass surgery.

As often happens in celebrity medicine, cardiologists cited Cheney's case in making a point about heart disease, which is the leading cause of death in this country. At a news conference, for example, an expert entered data from Cheney's case into a hand-held computer to illustrate how processing the information with data from key medical studies could help doctors deliver state-of-the-art care starting in the emergency room and continuing after discharge.

President Bush paid tribute to the research that enabled Cheney, 60, to survive four heart attacks since he was 37, a coronary bypass operation in 1988 and allowed him to reach high office.

Six years ago, the American College of Cardiology asked Cheney to speak at its annual meeting and paid his $10,000 fee.

This year, Bush invited himself to the meeting, described Cheney as a model patient who exercised regularly and pushed away desserts, and jocularly said Cheney stayed home because "he said he has seen enough cardiologists lately."

Cheney and his doctors have provided substantial but not full details of his case in news conferences and interviews. His apparently successful treatment has led some cardiologists to publicly criticize their profession for not beating its own chest to show how an improved understanding of heart disease and development of newer drugs and sophisticated technologies have extended Cheney's life.

Turning Cheney into a teaching case was one response to such criticism, and it generally met with favor despite the objections of one moderator of a panel at a news conference.

Dr. David R. Holmes Jr. of the Mayo Clinic in Rochester, Minn., refused to allow cardiologists to answer a reporter's question about how new findings from a study under discussion might apply in a case like Cheney's.

The question concerned treatment of restenosis, the complication Cheney recently developed after a stent was placed in a coronary artery in November. In rejecting the question, Holmes said he wanted a scientific discussion and not speculation about an individual patient. …