Myocardial laser revascularization in the year 2000 as seen by a Norwegianspecialist panel - The process of evaluating and implementing new methods in clinical practice

Objective- ln Norway "Transmyocardial laser revascularization" as a routine method was prohibited by the Ministry of Health in 1995 due to lacking evi dence of treatment effect and concerns about procedural morbidity and morta lity. In 1999 Norwegian health authorities asked for a re-evaluation of the method based on a systematic review of literature. Methods-Medline and Embase were searched and a total of 267 articles were i dentified. Publications were classified by an expert panel according to typ e of study and importance for the project. Results -Based on the Literature review the panel concluded that heart lase r treatment does not have a life-saving effect, nor does it improve myocard ial function. However, the method has a considerable short-term symptomatic effect, the mechanism of which is not understood. Neoangiogenesis, denerva tion and placebo may play a role. Based on the report the Norwegian health authorities recommended use of this method be restricted to scientific tria ls only. Conclusions-Based on a systematic literature review it was concluded that t he only documented effect of heart laser treatment is symptom relief, the m echanism for which is unclear. It could partly or totally be a placebo effe ct. A conflict of interest may arise when new technologies are to be implem ented in health care. The communication between professionals evaluating sc ientific results and decision makers is challenging. Quality assurance of t his process may be obtained by use of expert panels working under the auspi ces of an official institution.