Are Doctors Doing Too Many Invasive Heart Tests?
Posted by Catherine Morgan on March 12, 2010
Every year more than a million people in the United States are given an angiogram to check for blocked arteries, but in many cases the tests reveal no significant blockage.
Does that mean that all of these tests were unnecessary? Not at all. The study suggests that doctors begin to do a better job determining which patients really need an angiogram…Specifically, that careful evaluation be done when patients have no known heart disease and they are not in an emergency situation.
Patel thinks that “the entire diagnostic process from start to finish needs reevaluation — from talking to patients to the threshold for going invasive,” meaning angiography.
The best place to start, he says, is with patients without symptoms of heart disease, such as chest pain. Almost 1 in 3 Americans who get angiograms today are symptom-free. Their doctors order angiograms presumably because they suspect “silent” heart disease, perhaps because a patient has a family history of coronary disease, diabetes or other risk factors.
But angioplasty and stenting–procedures commonly done during angiography to widen clogged coronaries and keep them open–have never been shown to lengthen life, Patel says. The reason for doing them is to relieve symptoms. And if a patient doesn’t have symptoms, then doctors and patients should ask themselves what’s the point of doing the angiogram — instead of reducing coronary disease risk factors.
From the Wall Street Journal…
Typically, patients suspected of heart disease based on family history or, say, unexplained chest pain, first undergo non-invasive tests such as a stress echocardiogram or nuclear perfusion study to see how well the heart is functioning. Guidelines suggest such tests should indicate a potential problem before a patient is referred for an angiogram. In the study, 84% of patients got at least one of these tests, but the information they provided was only modestly helpful in predicting whether patients had significant disease. Researchers said this underscored the need to find more effective ways to recommend patients for angiograms.
Other factors contribute to demands for more angiograms, doctors say. Among these: financial incentives for doctors to perform angiograms, worries of malpractice suits if a blockage is missed on early tests, and patients demanding more specific information about their condition.
“Our whole system is incented to do more,” says Chet Rihal, a cardiologist and director of the catheterization clinic at Mayo Clinic in Rochester, Minn. “We’ve got to get much smarter about how we’re ordering and interpreting these tests.”
What do you think? Do the benefits of angiograms outweigh the risks for patients without known heart disease?