Cost-benefit of combined use of acupuncture, Shiatsu and lifestyle adjustment for treatment of patients with severe angina


Cost-benefit of combined use of acupuncture, Shiatsu and lifestyle adjustment for treatment of patients with severe angina pectoris

Coronary artery by-pass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) are current treatments of choice for severe angina, but with 28% complication rates over 3 years. Repeat surgery might be needed in 9% and 52% respectively within 3 years. In the trial reported here, acupuncture of BL.14 and 15, and CV. 17 was given 12 times in 4 weeks to 69 angina patients. None were excluded: 49 were candidates for surgery. Shiatsu massage of the 3 acupoints was taught, to be performed twice daily. Patients were informed of dietary, exercise and lifestyle adjustment, and stress coping techniques. They were compared with the 392 patients in a recent study of CABG and PTCA treated angina. The groups were fairly comparable, with slightly fewer males, 6% less group II-IV (NYHA), less beta-blocker use, more heart failure and more prior myocardial infarction in the acupuncture group. Of the acupuncture group, 23% had had prior surgery compared with none of the 392 comparison group.

A two year review showed combined death and myocardial infarction rates of 21%, 15%, and 7% respectively for CABG, PTCA, and acupuncture Shiatsu-lifestyle treatments, but with a higher death and lower Ml rate in the study group. Only 30% of the acupuncture group of patients who were due to have surgery in fact had either CABG or PTCA. NYHA rating of class 0-1 and medicine usage were a bit less, but fairly favourable for acupuncture. Annual visits to GP, cardiologists and hospital outpatient clinics were greatly reduced over the 2 year period, as was hospital admission. Medicine usage dropped over 70%. The estimated saving was US$500,000 over the two study years. The patients no longer requiring surgery saved another $448,000. A number were sufficiently better to return to work, saving a good bit in sick-payment. Expenses for acupuncture treatment totalled $130,000 over 2 years. Psychological testing appeared comparable for the conventionally treated and acupuncture treated groups.

Comment: This elegant study, designed to gladden the heart of the medical care purchaser, if not surgical provider, had no direct control group, so the authors used results from another recent excellent study for comparison. The patient groups were quite similar, and statistical manipulations beyond my ken were used to assure a balanced control. The acupuncture approach is simple to do, using the upper heater or chest control point and the MH and He Shu points of the bladder meridian. Treatment was short, the shiatsu follow-up left to loved ones, and education initiated in the lifestyle changes needed to survive with reasonable joy of life.

Acupuncture is thought to decrease sympathetic tone, helping open the cardiac arterioles for better nourishment. It is interesting that 92% continued Shiatsu to acupoints after 2 years, while 72% continued adequate exercise and 94% ate healthy food "at least inconsistently" Think what total compliance (not likely in a real world) might provide!

The British Medical Acupuncture Society.

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