My interest here is not the proposed law. It's the resistence of the Local Cardio community to screening.
Bill of health?
Oliviera's bill would require private insurance companies to cover a minimum of $200 (less if the cost of the test was less) for coronary artery calcium (CAC) screening using computed tomography (CT) and/or carotid ultrasound screening in intermediate-risk individuals. As previously set out in the SHAPE recommendations, this would include men between the ages of 45 and 75 and women between 55 and 75 who are at intermediate or high risk of a heart attack according to their Framingham Risk Score.
Oliveira has previously said that he believes his screening test saved his life.
Texas lawmakers once again mull controversial bill based on SHAPE cardiac-screening proposal
March 10, 2009 | Shelley Wood
Houston, TX - A bill that would mandate private insurance companies to cover the cost of cardiac screening in people at intermediate risk of a cardiac event is going before the Texas legislature for the second time today. The Heart Attack Prevention Bill, to be introduced by representative René O Oliveira (D-Brownsville), is based in large part on the controversial Screening for Heart Attack Prevention and Education (SHAPE) task-force recommendations calling for blanket screening for subclinical atherosclerosis [1].
This is the second time that Oliviera has tried to convince Texas legislators to pass his bill. As reported by heartwire, his first attempt—launched his first full day back in office after CABG surgery (a procedure he underwent after a CT scan indicated severe coronary blockages)—was rejected by the House Insurance Committee in February 2007. A staffer for Oliveira confirmed that he introduced the bill again, identical to the first, and a new hearing was called for March 10.
According to Oliviera's chief of staff, JJ Garza, the bill's hearing is set for 2:00 pm CT, but it is unlikely the committee will vote on the bill today.
"Normal practice is to hear a bill, then wait at least a week before bringing it up for consideration for a vote," he told heartwire. "This gives anyone who did not know about the hearing to come forward, and it also provides an opportunity for people to get answers to questions that could not be answered at the hearing for whatever reason. So, the fact that there will be no vote on Tuesday is not indicative of whether or not the bill has support."
Support for the bill
Indeed, backing for the bill may hinge on the support—or lack thereof—from the major cardiology societies. As previously reported by heartwire, the SHAPE task force was organized and funded by the Houston-based Association for Eradication of Heart Attack (AEHA), founded by Dr Morteza Naghavi (American Heart Technologies, Houston, TX) and dedicated to researching mechanisms, prevention, detection, and treatment of acute MI. The SHAPE recommendations, which billed themselves as "practice guidelines," were published in a Pfizer-sponsored supplement in the American Journal of Cardiology but were not supported by either the AHA or the ACC [1]. Boosting their credibility and authority, however, the writing group and editorial committee contained a long list of prominent cardiologists, and Dr Valentin Fuster (Mount Sinai School of Medicine, New York) was the guest editor and reviewer for the document.
Back when Oliveira introduced the bill the first time, the AHA and ACC distanced themselves from the bill, provoking criticism that ultimately found a voice in a JAMA Commentary [2].
A press release issued by the SHAPE society yesterday included a statement from Naghavi claiming that the AHA "has elected to support the bill."
But contacted by heartwire, a spokesperson for the AHA's South Central Affiliate in Austin, TX, confirmed that the AHA "has not changed its position regarding proposed Texas legislation mandating insurance reimbursement for heart attack preventive screenings.
"Locally, the AHA has consistently maintained that we follow the national center scientific guidelines and research, which, at this time, do not support such legislation. . . . The original [SHAPE society] press release that was issued Monday, March 9, incorrectly stated the AHA's support. The mistake was simply a miscommunication."
The AHA's denial of support for Oliveira's bill was first reported on Cardiobrief.
The SHAPE offices, meanwhile, acknowledged that some degree of "miscommunication" had occurred and that it had redacted the statement about the AHA's support from its press release after an Oliveira staffer was told that the "verbal commitment he had received from AHA representative Joel Romo to support the bill is no longer on the table."
In advance of today's hearing, a SHAPE spokesperson issued a statement saying: "We are extremely disappointed that, only hours prior to the hearing, the AHA has backed out from supporting such monumental bill, and, instead, wishes to remain 'neutral.' However, SHAPE remains hopeful that as new studies uncover in the field, the AHA will reconsider its position."
Also contacted by heartwire, an ACC spokesperson stated that ACC staff say for now that they are "not sure this bill will get anything more than a public hearing" and that the ACC "no longer takes positions on state legislation."
theheart.org |
