Overtesting Your Heart

 

According to research by the American Heart Association and published in the journal Circulation earlier this year, about half of all US adults who undergo a heart procedure or test did not need it. 

The issue of "low-value" medical care is a longstanding one, the heart association notes. The term refers to health care services that are unlikely to benefit patients in a meaningful way, exposing them to potential harm and wasting money. It's estimated that low-value medical care accounts for about 30% of health care spending in the United States — or up to $101 billion annually.

Among the low-value tests and treatments are annual exercise stress tests for people who have undergone angioplasty or surgery to clear blocked arteries, echocardiograms to assess people who have fainted but show no signs or symptoms of heart problems, and coronary calcium tests for people already known to have heart disease.

Individual doctors may rely on their personal experience, and the belief that a test or treatment helps patients, and just stick with it. Or they may simply be unaware of the evidence that a given practice is actually low-value. Then there is the fear of being sued, which can prompt doctors to practice "defensive medicine" and order tests to be sure nothing was missed.

Research suggests that up to half of stress tests performed in the United States would be rated as "rarely appropriate," the AHA says. The problem with that is not only time and money wasted but that it can also lead to invasive testing that carries more risks and yet more expense.

What can be done? Actions on different levels are needed, said Dr. Vinay Kini, chair of the AHA statement writing group.

On the broad level, the U.S. health care system is designed to reward quantity — more tests, more treatments — versus quality. A payment system based on quality of care is the "way forward," Kini said, though it is complicated to define quality. Patients also play a role.. In some cases, they demand tests or treatments that are not necessary, and their provider accommodates them.

What should you do? Be skeptical. Unless it is an emergency, like a heart attack, have a conversation with your provider about any tests being recommended and be sure that you fully understand not only the reason for the test but also the risks and benefits of going ahead with it. The final decision is yours.