More than half of Americans undergoing angioplasty to open their arteries are not having a recommended cardiac stress test in advance.
That means the procedures are being performed without first determining who will benefit from the procedure and who will not.
That’s the finding of a report in the Journal of the American Medical Association (JAMA).
Researchers from the University of California, San Francisco, the Maine Medical Center, and the Dartmouth-Hitchcock Medical Center, analyzed the records of nearly 24,000 Medicare patients who were age 65 and older and undergoing elective percutaneous coronary intervention, or PCI, also known as angioplasty and cardiac stenting.
The procedure is used to hold open narrowed arteries going to the heart in patients who suffer from chest pain.
In the U.S., 44.5 percent of patients underwent stress testing within the 90 days prior to elective PCI.
A stress test, generally recommended before a PCI is performed, includes walking on a treadmill to determine how well the heart handles a work load. The heart rate, breathing, blood pressure, electrocardiogram all measure how tired the patient feels during the test.
"We didn't expect to find 100 percent, but we expected a much higher percentage than 44," said Dr. Rita F. Redberg, professor of medicine at the University of California, San Francisco, to U.S. News.
The stress tests were delivered depending on the age of the doctor doing the PCI and in some cases dependant on the region.
Doctors in the Northeast and Midwest more frequently performed a stress test. Women were least likely to have one as was anyone over the age of 85 years. Stress tests were more likely to be ordered by a doctor under the age of 40 or over the age of 70, the research finds.
Researchers could not determine why the majority did not have the test except that guidelines are not as clear as they could be. New guidelines are set to be released shortly by the American College of Cardiology.
Conclusion – that at a cost of $10,000 to $15,000 per procedure, the outcome for PCI may be no better at stopping heart attacks and deaths than medications.
“We need to look at how we’re spending our money and can we spend it more wisely with a better return on our investment in health care. Right now, we have a system that pays the same for inappropriate and appropriate care. There should be a restructuring of incentives,” said author Redburg. #