Why I Believe in Thoughtful Heart Care by Andrew Rudin MD

When I first entered medicine, I imagined cardiology as a field of fast action—saving lives, opening blocked arteries, placing stents, rushing into the cath lab with urgency and purpose. And in many cases, that’s still true. There’s nothing more profound than restoring blood flow to a dying heart muscle during a heart attack. It never gets old. It never stops feeling miraculous.

But after more than 20 years in this field, I’ve come to believe that the most powerful thing we can offer patients isn’t always a procedure—it’s a pause.

Today, I practice cardiology in Tennessee, where the need for heart care is great. I see patients from all walks of life, many of whom are scared, confused, or overwhelmed by what they’ve been told elsewhere. Some have been rushed through tests. Some have been handed a diagnosis without context. Many have been told, “You need a stent,” without ever being asked a single question about how they feel.

That’s why I say it, often and unapologetically: “Think Before You Stent.”

Let me explain why.

The Procedure We’ve Come to Expect

Coronary stents—tiny metal tubes placed in arteries—are one of the great advances in cardiovascular medicine. When someone is having a heart attack, a stent can reopen a blocked artery and prevent irreversible damage. In that setting, stents save lives. I’ve performed many of those procedures, and I’m grateful we have them.

But what’s less well-known is that most stents in the U.S. are placed in patients who are not having a heart attack. They’re stable. They may have some mild symptoms, or none at all. And the question becomes: does this patient actually need a stent right now—or have we simply stopped thinking about whether they do?

What the Research Shows

We have excellent data now—especially from the COURAGE and ISCHEMIA trials—showing that for patients with stable coronary artery disease, stents do not lower the risk of future heart attacks or death compared to medical management. That’s a paradigm shift.

In other words, if you’re not in an emergency situation, and you don’t have severe symptoms that haven’t responded to medication, placing a stent often does not improve long-term outcomes. It may relieve angina (chest pain) in some cases, but that’s not always a guarantee either.

So why do we keep placing them so reflexively?

Part of it is culture. Part of it is the legacy of old assumptions. And yes, part of it is economics—our healthcare system often rewards doing more, not necessarily doing better.

What I Tell My Patients

When someone walks into my office after being told they need a stent, the first thing I do is ask how they’re feeling. Not just physically, but emotionally. Do they have chest pain? Is it frequent? Does it limit their daily life? Have they tried medications? Do they understand what the test results mean?

Then I walk them through the evidence—plainly, without jargon. I explain what a stent can and cannot do. I explain the risks, the potential benefits, and the alternatives. Most importantly, I make space for their questions.

Because patients deserve to understand their condition—and to be involved in choosing how it’s managed.

One of the most powerful moments I’ve witnessed was when a patient said, “You’re the first person who explained this to me in a way that makes sense.” That’s not a clinical achievement. That’s a human one.

The Risks We Don’t Always Discuss

People often assume that stents are “routine” or “low risk.” But every medical procedure carries potential harm. Even elective stents can cause bleeding, allergic reactions, damage to arteries, or complications from the blood thinners patients must take afterward. And those blood thinners can raise the risk of serious bleeding or interfere with surgeries down the road.

If the stent truly improves life or prevents danger, those risks may be well worth it. But if not—why take them?

That’s why I say: let’s pause, think, and decide carefully.

Practicing in Tennessee: A Return to Relationship

Here in Tennessee, where I now practice full time, I’ve found space to slow down and reconnect with the roots of medicine. This region has some of the highest rates of heart disease in the country. People are facing real challenges—access to care, economic stress, high blood pressure, diabetes, and lack of preventive infrastructure.

But they’re also incredibly engaged. They want to understand. They want to get better. And when I take time to explain how lifestyle changes, medication, and stress management can prevent a future heart attack, the response is almost always the same: “Why hasn’t anyone told me this before?”

The truth is, there’s no billing code for education. But in my opinion, it’s the most valuable thing we offer.

Beyond Procedures: Building Trust

“Think Before You Stent” is not just about stents. It’s about how we think as doctors. It’s about resisting the urge to fix something just because we can. It’s about taking a step back and asking: Will this make my patient healthier? Or just busier, more anxious, more at risk?

We have incredible tools in medicine today—but tools are only helpful when used with wisdom. That wisdom comes from experience, from ethics, and from knowing the person in front of you.

I’ve learned that patients remember how you made them feel more than what you prescribed. They remember whether you looked them in the eye. Whether you explained, not just ordered. Whether you cared.

That’s the kind of medicine I practice. And that’s the kind I want to see more of.

My Message to Patients

If you’re reading this and you’ve been told you need a stent—don’t panic. But do ask questions.

Ask:

• Is this urgent?
• Are my symptoms stable?
• Have I tried medications or lifestyle changes?
• What do the studies say about people like me?
• What happens if I wait?

And above all, find a doctor who takes the time to explain—not just act. Find someone who will treat you, not just your artery.

Final Thoughts

Cardiology is evolving. We're moving away from the idea that every abnormal test demands immediate action. We're learning that the best care is not always the most aggressive—it’s the most appropriate.

As a cardiologist, I still use stents. I still believe in intervention when it’s needed. But I’ve come to value conversation even more. Because a stent can open an artery—but a conversation can open a future.

Let’s slow down. Let’s think. Let’s listen.

That’s how real healing begins.

—

Andrew Rudin, MD

Cardiologist | Electrophysiologist | Patient Advocate

Practicing in Tennessee

Champion of prevention-first, ethics-based heart care