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Heart Testing Overused, Report Finds

Direct-to-Consumer Ads Mislead Public, Consumer Reports Says
By
WebMD Health News
Reviewed by Laura J. Martin, MD

Man undergoing exercise stress test

Aug. 2, 2011 -- Far too many healthy Americans are undergoing heart screening tests, which can lead to unnecessary and potentially dangerous treatments. That’s according to an investigation appearing in next month’s Consumer Reports.

In a survey of more than 8,000 subscribers, nearly half (44%) of those without major heart risk factors or symptoms reported having a screening test such as an electrocardiogram, exercise stress test, or ultrasound of the carotid arteries.

These tests, which are done to identify blockages, are not recommended for the vast majority of healthy people without symptoms of heart disease, such as chest pain or shortness of breath.

That’s because interventions like angioplasty to clear blocked arteries may do more harm than good in this group, Consumer Reports Health Ratings Center Director John Santa, MD, MPH, tells WebMD.

“We know that obstructions caused by plaque in the arteries are actually very common, even in young, healthy adults,” Santa says. “While these tests are very appropriate in people with symptoms, they clearly lead to the overuse of invasive treatments in people who do not have symptoms.”

He adds that although heart screening is being overused, interventions proven to lower heart attack and stroke risk, such as controlling blood pressure and cholesterol, are being underused.

Too Many Angioplasties Performed

About 600,000 angioplasties with or without stents are performed in the U.S. each year at a cost of more than $12 billion.

In an analysis of 500,000 procedures published last month, researchers judged almost half of the angioplasties performed in people with few or no symptoms to be either questionable or inappropriate.

The use of angioplasty among Medicare recipients has increased by 300% over the last decade.

Santa says the push to test and treat with angioplasty stems from the outdated notion that heart disease is just a ‘plumbing problem’ that clearing the blocked plumbing, or artery, will fix.

“We now know that heart disease is also a clotting problem,” he says. “Plaque could sit in the arteries for many, many years without causing a problem, but an (artery-blocking) clot can form very quickly.”

Angioplasty with stents can actually cause clotting, and that is why the procedure may increase the risk for heart attacks and strokes in people without heart symptoms, says Kimberly Lovett, MD, of the San Diego Center for Patient Safety at the University of California, San Diego.

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