Feature | April 01, 2013

Stress Echo May Be Overused, Leading to False Patient Diagnoses

The American Society of Echocardiography lists five things physicians and patients should question

February 21, 2013 — The American Society of Echocardiography (ASE) has released a list of five interventions whose appropriateness physicians and patients should discuss as part of Choosing Wisely, an initiative of the ABIM Foundation, along with Consumer Reports. Fourth in the list, they ask that patients and their doctors talk about the real need for a stress echocardiogram if they do not present conditions that would warn them of a risk of heart disease.

Avoid using stress echocardiograms on asymptomatic patients who meet “low-risk” scoring criteria for coronary disease.

Prior to ordering or undergoing a stress echocardiogram a patient’s risk factors and symptoms should be carefully assessed. The presence of risk factors for heart disease and/or symptoms suggestive of coronary artery disease improves the chance that an abnormal test will reflect true disease in the heart.

Stress testing is performed to determine whether or not there are blockages in the arteries of the heart and whether or not the blockages are severe enough to affect blood flow to the heart. During a stress echocardiogram the heart is challenged either by exposure to exercise or to medications that can simulate the work of exercise. Echo pictures are taken at rest and then following the stress component of the test. Using echo, the presence of a significant blockage causing wall motion abnormalities can be readily identified by evaluating the pumping of the heart muscle. A positive test is a marker of an increased risk of adverse heart events and often leads to further testing such as a cardiac catheterization or aggressive use of medications.

Because of the potential implications of a diagnosis of heart disease, it is important to make sure that the results of the test are accurate. Performing the test in individuals who have some risk for heart disease increases the chances that a positive represents true disease. Risk factors for coronary artery disease, using the scoring mechanism common in patient heart evaluations, include cigarette smoking, high blood pressure, high cholesterol, positive family history of heart artery disease, obesity, inactivity, diabetes mellitus and peripheral vascular disease. Having one or more of these factors increases the likelihood that chest pain actually represents underlying heart artery disease. Symptoms suggestive of heart artery disease include pressure/pain in the mid-chest that occurs with exertion. The discomfort can also spread to the arms, back, neck or jaw, and can be associated with shortness of breath.

Individuals without these symptoms or risk factors for heart disease are less likely to have heart artery blockages and should not undergo surveillance stress echocardiography or any other stress test due to the risk of obtaining a falsely positive test.

The goal of Choosing Wisely is to promote conversations between physicians and patients about utilizing the most appropriate tests and treatments and avoiding care that may provide no benefit.

ASE’s testing cardiovascular care scenarios were chosen based on the highest likelihood of improving patient care and reducing inappropriate test use. Leaders in the organization transformed the scenarios into plain language and produced the clinical explanations for each procedure. In particular, ASE’s cardiovascular care experts, reviewed the ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriateness UseCriteria for Echocardiography (AUC), which was published in March 2011.

ASE encourages all medical professionals engaged in cardiovascular care to read the “Five Things Physicians and Patients Should Question” and to engage patients in conversations about reducing inappropriate tests and procedures with a goal of improving care and avoiding harm.

Consumer Reports, along with a coalition of consumer partner organizations, is also a part of the Choosing Wisely effort and is working with many of the societies to help patients understand the tests and treatments that are right for them.

For more information: www.asecho.org, www.choosingwisely.org

Related Content

ASNC Announces Multisocietal Cardiac Amyloidosis Imaging Consensus
News | Cardiac Imaging | September 09, 2019
September 9, 2019 — The American Society of Nuclear Cardiology (ASNC) published a new expert consensus document along
Medical Imaging Rates Continue to Rise Despite Push to Reduce Their Use
News | Radiology Imaging | September 03, 2019
Despite a broad campaign among physician groups to reduce the amount of medical imaging, use rates of various scans...
Philips Debuts Cardiac Ultrasound and Enterprise Informatics Offerings at ESC 2019
News | Cardiac Imaging | August 30, 2019
Philips will showcase its latest cardiac care innovations at the European Society of Cardiology (ESC) Congress 2019,...
CIRS Launches Ultrasound Quality Assurance Software
Technology | Quality Assurance (QA) | August 30, 2019
August 30, 2019 — The CIRS Ultrasound...
Terason Partners With DiA Imaging Analysis for Point-of-care Cardiac Ultrasound AI
News | Cardiovascular Ultrasound | August 26, 2019
Ultrasound imaging company Terason has partnered with DiA Imaging Analysis, provider of artificial intelligence (AI)-...
Exo Imaging Raises $35 Million for Developmental Ultrasound Platform
News | Ultrasound Imaging | August 23, 2019
Exo Imaging Inc. announced a $35 million Series B financing round for its high-performance ultrasound platform based on...
Improved Imaging Technique Could Increase Chances of Prostate Cancer Survival
News | Prostate Cancer | August 20, 2019
According to the American Cancer Society, approximately one in nine men will be diagnosed with prostate cancer in their...
Profound Medical Receives U.S. FDA 510(k) Clearance for Tulsa-Pro
Technology | Interventional Radiology | August 16, 2019
Profound Medical Corp. announced it has received 510(k) clearance from the U.S. Food and Drug Administration (FDA) to...
Contrast Use in First Transthoracic Echocardiogram for Heart Failure Reduces Repeat Testing
News | Cardiovascular Ultrasound | August 07, 2019
Heart failure is the fourth most common cause for all admission to U.S. hospitals, and it is the most common reason for...