Unnecessary cardiac stress test imaging costs $501M a year

The overuse of imaging services for cardiac patients takes a fiscal toll on both the healthcare system and the patients who undergo them, the American Journal of Managed Care reported.

Excess imaging services cost the healthcare system as much as $501 million annually, according to a new study by researchers at NYU Langone Medical Center. Perhaps more disturbingly, the researchers concluded that the excess imaging has a price for patients: The unnecessary radiation exposure creates an additional 491 cases of cancer every year.

The overuse of radiology services is particularly severe in conjunction with cardiac stress tests, Joseph Ladapo, M.D., an NYU assistant professor in the departments of medicine and population health, told AMJC. He noted that the use of imaging in conjunction with cardiac stress testing skyrocketed back in the 1990s.

The researchers based their study on data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. They discovered the average annual rate of ambulatory visits in the United States that resulted in a cardiac stress test being ordered or performed rose from 28 per 10,000 visits among adults without coronary heart disease during the 1993-95 period to 45 per 10,000 visits in 2008-10. Meanwhile, the percentage of stress tests accompanied by imaging grew from 59 percent in 1993-95 to 87 percent 2008-10.

The use of imaging is growing in other areas as well, such as in hospital emergency departments and in cancer care, although its rate of growth has been slowing in recent years.

Ladapo and the research team used criteria from the American College of Cardiology, the American Society of Nuclear Cardiology and the American Society of Echocardiography to determine whether imaging with a stress test was appropriate. They determined that 34.6 percent of the time it was not.

"People have less time. They are rushing. There's less time to talk to patients and get a sense of their symptoms, and the alternative is testing," Ladapo told AJMC.

To learn more:
- read the AJMC article