Cardiac Stress Tests Increase Over Two Decades

Joseph A. Ladapo, MD, PhD New York University School of Medicine Department of Population Health New York, NY 10016 MedicalResearch.com Interview with:
Joseph A. Ladapo, MD, PhD
New York University School of Medicine
Department of Population Health
New York, NY 10016


Medical Research: What are the main findings of the study?

Dr. Ladapo: We showed that the use of cardiac stress testing has risen briskly over the past two decades, with the use of imaging growing particularly rapidly. We also showed that national growth in cardiac stress test use can largely be explained by population and provider characteristics, but the use of imaging cannot. Importantly, nearly one third of cardiac stress tests with imaging tests were probably inappropriate, because they were performed in patients who rarely benefit from imaging. These tests–about 1 million each year–are associated with about half a billion dollars in healthcare costs annually and lead to about 500 people developing cancer in their lifetime because of radiation they received during that cardiac stress test.

Medical Research: What was most surprising about the results?

Dr. Ladapo: The sheer number of imaging cardiac stress tests being performed. We focused on patients without a known history of coronary heart disease, and this is not a population that routinely needs or benefits from imaging. But the fact is that most tests in this population are being performed with imaging.

Medical Research: What should clinicians and patients take away from your report?

Dr. Ladapo: Inappropriate cardiac stress tests are increasing healthcare costs and contributing, though only marginally, to the incidence of cancer. Clinically, we need effective decision support tools to help physicians more appropriately identify patients who would benefit from imaging cardiac stress tests.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Ladapo: We need to better understand what ecological, behavioral, and economic factors drive physician decision making and increase the use of more intensive technologies with marginal incremental value.

Citation:

Physician Decision Making and Trends in the Use of Cardiac Stress Testing in the United States: An Analysis of Repeated Cross-sectional Data

Joseph A. Ladapo, MD, PhD; Saul Blecker, MD, MHS; and Pamela S. Douglas, MD
Ann Intern Med. 2014;161(7):482-490. doi:10.7326/M14-0296