There has been a great deal of concern raised by patients over the costs of what may be inappropriate testing. Researchers have backed up these concerns with findings from a recent study showing that in patients at high risk for coronary artery disease, noninvasive cardiac imaging had only a small impact on clinical management, therefore suggesting that many tests were inappropriate. Todd Neale has reported for Medpage Today "Heart Scans Have Modest Effect on Patient Care."
The researchers reported in the January 31 issue of the Journal of the American College of Cardiology that the failure to use recommended medications even in these high-risk patients suggests that many patients are being undertreated. According to Marcelo Di Carli, MD, of Brigham & Women's Hospital in Boston, and colleagues referral for catheterization and medication changes were more frequent as the degree of abnormal findings on various imaging tests increased, however the overall effect was modest, particularly among patients with the most abnormal results.
It was found that "even when patients had moderately to severely abnormal results on SPECT, PET, or CT angiography (CTA), 38% to 61% were not referred for catheterization, 20% to 30% were not receiving aspirin, 35% to 44% were not receiving a beta-blocker, and 20% to 25% were not receiving a lipid-lowering agent by the 90-day follow-up." The researchers wrote "In light of the costs associated with cardiovascular imaging, it is problematic to justify the use of testing that will not be incorporated into subsequent patient care. A noninvasive procedure, the results of which have no impact on subsequent management, must be considered an inappropriate study; the current study suggests that a significant amount of inappropriate noninvasive procedures are currently performed."
According to the researchers the limited changes in catheterization rates and medication use which were found after abnormal study findings, particularly in the highest-risk group, undermine the idea that use of noninvasive cardiac imaging is justified based on its importance in managing patients. Di Carli and colleagues concluded "The results of the current study suggest that patient management after noninvasive cardiac imaging should be considered a necessary component of the definition of imaging quality."
