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New Guidelines Call for No Heart Tests for Low-Risk Patients
American College of Physicians advises against EKGs, stress testing, among othersTuesday, March 17, 2015
TUESDAY, March 17, 2015 (HealthDay News) -- Many patients who are at low risk for heart problems don't need to have screening tests such as EKGs and stress tests, a national association of primary care physicians recommends.
The new guideline jibes with research that has suggested the tests are overused in patients who don't need them.
"These tests are very unlikely to be helpful in low-risk patients. They are unlikely to give findings that will change patient management or improve patient outcomes," said Dr. Roger Chou, director of the Pacific Northwest Evidence-based Practice Center at Oregon Health & Science University. He is the lead author of the guidelines that were released Monday by the American College of Physicians.
At issue are electrocardiography (EKG or ECG), echocardiography (echo) and myocardial perfusion imaging (nuclear) tests. All of these can be used in "stress tests" that require patients to be monitored as they exercise. EKG tests can also be used in patients who aren't moving.
The new recommendations noted that no current screening guidelines appear to recommend cardiac screening in low-risk adults without symptoms. Still, many patients undergo the tests, Chou said. He pointed to a Consumer Reports survey that found 39 percent of adults without certain cardiac symptoms said they'd undergone the tests within the past five years.
Chou said doctors could find other ways to gauge the cardiac condition of patients who are at low risk. They can do this by using a cardiovascular risk "calculator" that takes various factors into account, he said.
"The percentage of patients that fit in the category of low risk varies, depending on age and sex," Chou said. "For example, most women in their 40s and 50s will be in the low-risk category. The risk goes up with age, and men tend to have higher risk than women."
If patients are at low risk of cardiac problems, "they can focus on addressing modifiable risk factors -- smoking, lipids, diet, exercise, etc. -- rather than obtaining an unnecessary test," he said.
If low-risk people do get unneeded cardiac screening, the study said, they could face unnecessary future testing because of "false positives" -- results that falsely suggest a problem -- and unnecessarily be exposed to radiation in nuclear stress tests.
In addition, these tests aren't cheap. An EKG typically costs about $50 and an exercise stress test costs about $200 to $300, according to Healthcarebluebook.com. Chou noted the prices can vary across the country.
Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, said the recommendations are consistent with those of the American Heart Association and American College of Cardiology. But he cautioned that they're designed for patients who don't have symptoms.
"Patients with symptoms that may suggest cardiovascular disease need additional testing, using one or more of these tests," he said. "In addition, this advice does not cover patients without symptoms who are at high risk for cardiovascular disease. Additional testing may be selectively considered in such patients."
The recommendations appear in the March 17 issue of the Annals of Internal Medicine.
SOURCES: Roger Chou, M.D., professor and director, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Ore.; Gregg Fonarow, M.D., professor, cardiology, University of California, Los Angeles; March 17, 2015, Annals of Internal Medicine
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