From Our 2011 Archives
Many in U.S. Get Unneeded Heart Screening Tests
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Survey Suggests Healthy Americans Get Tests That Could Expose Them to Unnecessary Risks
By Kathleen Doheny
Reviewed by Laura J. Martin, MD
Feb. 3, 2011 -- When it comes to heart screening tests, healthy Americans may be a little too test-happy, according to a recent survey conducted by Consumer Reports.
In July 2010, Consumer Reports polled 8,056 of its subscribers, ages 40 to 60, who had seen a doctor in the last 12 months and were free of any heart-related condition that might warrant heart-specific screening tests.
"This survey showed that even healthy people are having screening tests that don't work that well, could expose them to risks, and that they are going to end up having to pay for," John Santa, MD, MPH, director of the Consumer Reports Health Ratings Center, tells WebMD.
Santa and his team found that 44% of healthy adults with no heart disease risk factors reported that in the last five years they had had a heart-specific screening test other than routine blood pressure monitoring and blood work. The tests included an electrocardiogram (EKG) and an exercise stress test.
Based on recommendations from experts and the survey respondents' age and risk factors, the researchers determined that many of these tests were not needed.
In some cases, people had tests that have little evidence of benefit; in other cases, the tests might have been beneficial if they were older and had a history of smoking, for instance.
"EKGs and stress tests are not very helpful at any age in people who have no history of heart disease -- a heart attack, murmur, a heart rhythm problem -- no symptoms and no physical findings on examination that would create some concern that they might have heart disease," Santa says.
Rating Tests for Heart Disease
For the survey, the magazine rated nine medical tests that screen for heart disease, using recommendations from the U.S. Preventive Services Task Force and updating it with evidence and data published in reputable medical journals. The rating describes benefits, risks, and costs of each test depending on such factors as age and sex.
The nine tests include:
Positive Survey Results
On the plus side, the researchers found that 98% of those polled had their blood pressure checked. That's a good thing, says Santa.
Everyone over age 18 should have blood pressure checked when they visit their doctor and at least once every two years, he says.
Eighty-nine percent of respondents without heart disease risk factors and 97% of those with risk factors had their cholesterol checked. Consumer Reports recommends cholesterol screening for all men and for women at high risk every five years.
Beyond those tests, Santa says, whether a test will provide benefit or not depends on age, sex, and other factors.
Santa says the survey respondents didn't tend to ask why a test was needed, nor think of risks -- such as potential complications or the need for additional testing if the results weren't definite.
Patients ask too few questions about screening tests, says Ravi Dave, MD, a cardiologist at Santa Monica -- UCLA Medical Center & Orthopaedic Hospital, Calif.
He reviewed the survey findings for WebMD but was not involved in the survey.
"The common perception among patients is, 'If I am getting a test to check something out, it's a good thing,'" says Dave, also an associate professor of medicine at the University of California, Los Angeles David Geffen School of Medicine.
But, Dave says, the test is sometimes not necessary.
He urges patients to ask their doctor why the test is needed. "What you also need to ask is, 'Is this something that can be excluded by just a physical exam?'" he says.
SOURCES: John Santa, MD, MPH, director, Consumer Reports Health Ratings Center.Ravi Dave, MD, cardiologist, Santa Monica -- UCLA Medical Center & Orthopaedic Hospital, Calif.; associate professor of medicine, University of California, Los Angeles David Geffen School of Medicine.Consumer Reports Heart Disease Prevention Survey.