There is a procedure called a "catheterization" (hence "cath lab").

I have two stents in my heart. They went in with a catheter through an artery in my wrist. They found the places in my heart where the arteries were 80% to 90% blocked, and placed stents there. They said I was five years from a heart attack.

This was an outpatient procedure. I went home that night.

The worst part of it, for me, was that they put a serious tourniquet on my wrist, because once they took the catheter out, I had an open artery. My wrist felt like I lost a bar fight. It ached for a month.

This is so much better than having a heart attack.

How did they know I needed this? I talked to a cardiologist. He told me that, as you age, your athletic performance drops slowly, over decades. That's normal. What's abnormal is when you suddenly can't do something you were able to do a month ago.

So I paid attention when I realized, hey, a month ago I didn't get this winded playing ultimate frisbee. A month ago I recovered faster when I was winded.

So I told that to my GP. He ordered a cardiac stress test for me. This basically is hooking you up to an EKG, putting you on a treadmill, running the treadmill faster and harder until you drop, and watching what your EKG does. If the shape stays the same except faster, you're good. If the shape changes, that's part of your heart not getting enough blood under load. My shape changed. So they ordered the catheterization for me.

So cath labs are about preventing the heart attack, not keeping you from dying once you have one. Not dying is good. But not having it at all is better. I think that may have been the GP's point.

Which part needs to be explained? I think I understood the comment and I’m not in the industry. AED is an initialism for the electrical shock device you can use to (maybe) reboot the heart’s OS when it locks up. Catheters are some kind of tube that gets implanted to bypass a non-functional part of the heart. Catheter procedures improving caused the change, not AEDs (apparently), so it’s somewhat misleading to show an AED instead of something about catheters.

PCI (Percutaneous Coronary Intervention, performed in a catheterization laboratory) has become the usual first-line treatment for acute heart attacks.

It's much more effective than previous treatments (essentially clot-busting drugs, blood thinners, and bedrest), particularly since Drug-Eluting Stents arrived in the early 2000s.

What are AEDs? Aspirin? Blood thinners? I'm from the UK, so probably a naming difference!

It's not just a question of scaling up the screening effort. Doctors are also concerned with potential harms caused by false positives.

PCP is certainly not going to be the one doing the colonoscopy.

maybe they’d do the stool sample or some silly blood test if you are extremely insistent and can somehow demonstrate a risk factor.

I’ve dealt with a few PCPs and they seem less informed about their own area than a 30 sec google search.

They’re basically L6 tech support…

Colonoscopies here (midwestern US) are upwards of a couple thousand outside of the usual schedules enforced by insurance companies.

If there’s a complication they can easily skyrocket into the tens of thousands.

Most people around here can’t soak that.

Grandfather died of colon cancer at 43.

Went into my PCP at 40 asking for a colonoscopy, he said insurance wouldn’t cover it until I was 50.

…

Screenings are not risk-free. There are always some false positives which then may lead to more invasive and unnecessary tests or treatment. There are a lot of rare conditions (based on age and/or history) that we don't screen for on a routine basis.

Catching colorectal cancer at an early stage improves survival rates tremendously. You have to weigh the risk of complications from the colonoscopy (primarily bowel perforation) with the improved outcomes. There's a cost element as well, since colonoscopies (without complications) can be several thousand dollars.

Yes, colorectal cancer screening is estimated to reduce colorectal cancer mortality by 50% to 73%.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10093633/

https://www.nejm.org/doi/full/10.1056/NEJMoa2208375

Progressive screening using non-invasive assays like Cologuard and FIT is a valuable screening mode. The non-invasive assays are not perfect but they are improving.

this is why american medical care is so expensive. Family’s and Law make doctors “do everything” even when the doctors know there is 0.01% chance such a person even makes it out of the icu and that’s not saying anything about brain function.

Off the top of my mind, I can think of two patients who I personally cared for in the days or weeks after CPR who had an outcome other than death or vegetative state. One patient walked out the door two weeks after admission. The other patient regained consciousness and was able to speak/communicate, but was bed bound, appeared to have sustained some degree of cognitive damage, and had to receive feeds through a gastric tube. She was in the hospital for about six months before being discharged to a nursing facility. That's the numerator. It's hard to quantify the denominator. 40 or 50 maybe? But that's a guess.

Out-of-hospital arrests are that deadly. Those that occur in a hospital are somewhat more survivable.

Not a whole lot more, but if you're going to arrest you want to do it in a hospital with lots of nurses nearby.

Preventative care also seems to be an issue. Medicare denied a test for my dad to check the state of his heart, because it wasn't really having any symptoms. When he found out the test was only about $100, he just paid for it himself. He'll be going in for a quintuple bypass next week. I guess Medicare was content to wait for a heart attack.