Study Finds Risky Heart Tests Overused

Some popular cardiac screening tests might present dangers to patients, according to an investigation in next month’s Consumer Reports.

Web MD Health News reported that too many American patients undergo heart screens that can lead to unnecessary and potentially dangerous medical treatments. A survey of over 8,000 subscribers found that 44 percent who did not present with a major cardiac risk factor or heart symptoms underwent some type of screening, such as electrocardiogram, exercise stress test, or carotid artery ultrasound, said Web MD.

These screening tests are meant to locate blockages and are not recommended for most healthy people with no symptoms typical of heart disease, such as shortness of breath and chest pain, noted Web MD. But, procedures such as angioplasty, prescribed to clear arteries, could cause harm in healthy patients, John Santa, MD, MPH, the Consumer Reports Health Ratings Center Director told Web MD. “We know that obstructions caused by plaque in the arteries are actually very common, even in young, healthy adults,” Santa told Web MD. “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,” Dr. Santa added.

Meanwhile, noted Dr. Santa, while heart screens are overused, interventions to lower blood pressure and cholesterol are not used enough. Santa told Web MD that testing and treating with angioplasty has to do with an antiquated, and false, idea that cardiac disease is about “plumbing” and that clearing a clog will resolve the problem. “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,” Web MD reported.

Some 600,000 angioplasties with and without stents are performed in the U.S. annually, costing over $12 billion, said Web MD. A review published last month of over 500,000 procedures revealed that about half the procedures performed in patients with minimal or no symptoms were questionable or inappropriate, wrote Web MD.

Meanwhile, angioplasty with stents can result in clotting, which can increase heart attack and stroke risks in people with no heart symptoms, said Kimberly Lovett, MD, of the San Diego Center for Patient Safety at the University of California, San Diego, wrote Web MD. “Extensive cardiovascular testing is appropriate for many patients, but these tests should not be done routinely in people without symptoms and they should not be marketed to the public,” American Heart Association president Gordon Tomaselli, MD, told Web MD.

Last month, citing a similar study, we wrote that Steven Nissen, head of cardiovascular medicine at the Cleveland Clinic, told The Wall Street Journal that that study “tends to confirm concerns that many people have expressed—that there are many thousands of patients who undergo coronary interventions for very questionable indications.”

In December, we reported that Baltimore surgeon Mark Midei came under scrutiny for implanting allegedly unnecessary cardiac stents in hundreds of patients at St. Joseph’s Medical Center in Towson, Maryland. According to a Senate Finance Committee report, Abbott Laboratories, a stent manufacturer, provided Midei with many perks, such as pig roast to mark an occasion in which the surgeon may have broken an Abbott record by implanting 30 stents in one day. Midei is accused of needlessly implanting stents in over 500 patients, and could lose his medical license. In another case, 141 patients underwent unneeded angioplasties at Westmoreland Hospital in Western Pennsylvania in 2010. According to a report from The Pittsburgh Tribune Review, the questionable stents were implanted by Drs. Ehab Morcos and George Bousamra, who voluntarily resigned their privileges at Westmoreland in January.