A new study published in Annals of Internal Medicine has concluded that the overuse of cardiac stress testing with medical imaging has contributed to rising healthcare costs.
Patients have also been exposed to unnecessary radiation dose due to stress imaging tests, according to the study team led by Dr. Joseph Ladapo, PhD, at NYU Langone Medical Center (Ann Intern Med, October 7, 2014, Vol. 161:7, pp. 482-490).
The researchers analyzed data from 1993 through 2010 from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS). They included data on adult patients without coronary heart disease who were referred for cardiac stress tests.
The number of ambulatory visits in the U.S. in which a cardiac stress test was ordered increased by 50% between the two data collection periods, the first from 1993 to 1995 and the second from 2008 to 2010, Ladapo and colleagues found. The number of cardiac stress tests with imaging grew from 59% in the first period to 87% in the second.
What's more, the researchers calculated that more than 1 million tests -- some 34.6% of the total -- were probably inappropriate, costing the healthcare system about $500 million annually and causing 491 future cases of cancer a year.
While the overall growth of cardiac stress testing could be explained by patient and provider characteristics, the use of imaging could not, the researchers concluded. They recommended greater use of physician decision support to reduce unnecessary stress testing, and suggested regular exercise treadmill tests or stress testing with ultrasound rather than CT.
"Cardiac stress testing is an important clinical tool, but we are overusing imaging for reasons unrelated to clinical need. This is causing preventable harm and increasing healthcare costs," Ladapo said in a news release.
