Heart Testing Overused, Report Finds

Direct-to-Consumer Ads Mislead Public, Consumer Reports Says

By Salynn Boyles
WebMD Health News

Reviewed by Laura J. Martin, MD

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Santa says the push to test and treat with angioplasty stems from the outdated notion that heart disease is just a 'plumbing problem' that clearing the blocked plumbing, or artery, will fix.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

Ads Push Heart Scanning

The Consumer Reports investigation targeted direct-to-consumer advertising and marketing of high-tech heart tests by medical device manufacturers, hospitals, medical centers, and doctor groups as a particular concern.

One ad cited in the Consumer Reports report run by an Austin heart hospital read "Find a new way to tell Dad you love him. Show your love with a HeartSaver CT."

In an editorial published earlier this year in the Journal of the American Medical Association, Lovett wrote that the direct-to consumer ads exploit patient fears, and she called on the FDA to regulate them.

"When the medical technical revolution started we believed that the more testing we did the better off patients would be, and if we found something abnormal we should act on it," she tells WebMD. "We now know that acting on abnormal results can lead to harm."

Established Heart Treatments Work Well

The Consumer Reports report cites the web site Track Your Plaque, which promotes heart CT scans with the claim that "the old tests for heart disease were wrong -- dead wrong."

Santa says nothing could be further from the truth.

"The tests and interventions that we have known about for decades clearly work well and make a huge difference in terms of preventing heart disease," he says.

The Consumer Reports report lists six proven strategies for lowering heart risk that could save millions of lives.

They are:

  1. Get your blood pressure checked at least once a year and treat high blood pressure aggressively.
  2. Have your cholesterol tested and treat high levels with lifestyle modification and medication, if necessary.
  3. Lose some weight. People who are overweight or obese can lower their risk of heart attack and stroke by losing extra pounds.
  4. Have blood sugar levels tested if you have risk factors for diabetes and control blood sugar if you have the disease.
  5. Stop smoking. The American Heart Disease estimates that more than 3 million heart attacks and 1 million strokes could be prevented over the next three decades with effective smoking cessation.
  6. Talk to your doctor about the risks and benefits of taking low-dose aspirin if you have heart disease risk factors.

"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, tells WebMD.

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SOURCES: Consumer Reports: "The Business of Healing Hearts," September 2011.John Santa, MD, MPH, director, Consumer Reports Health Rating Center.Gordon Tomaselli, MD, president, American Heart Association; professor of medicine and director, division of cardiology, Johns Hopkins University School of Medicine, Baltimore.Kimberly Lovett, MD, investigator, University of California San Diego Center for Patient Safety; attending physician, Kaiser Permanente.News release, Consumer Reports.WebMD Health News: "Many Non-Emergency Angioplasties May Be Unnecessary."Chan, P. Journal of the American Medical Association, July 6, 2011; vol 306. ©2011 WebMD, LLC. All Rights Reserved.

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