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Summaries for Patients |7 October 2014

Trends in the Use of Stress Testing to Diagnose Coronary Heart Disease Free

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Author, Article, and Disclosure Information

  • The full report is titled “Physician Decision Making and Trends in the Use of Cardiac Stress Testing in the United States. An Analysis of Repeated Cross-sectional Data.” It is in the 7 October 2014 issue of Annals of Internal Medicine (volume 161, pages 482-490). The authors are J.A. Ladapo, S. Blecker, and P.S. Douglas.


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What is the problem and what is known about it so far?

People who are suspected of having blocked arteries in the heart are often tested by walking on a treadmill to stress the heart while its electrical activity is measured. Some stress tests also produce images of the heart, and some methods that produce the images expose patients to radiation. Many observers believe that stress testing with imaging is an important source of rising health care costs and radiation exposure, but not much is known about time trends.

Why did the researchers do this particular study?

To determine whether trends in stress test use may be attributable to time trends and evaluate whether racial/ethnic differences exist in physician decision making.

Who was studied?

Patients who were representative of the U.S. population, were aged 18 years or older, and had a stress test between 1993 and 2010.

How was the study done?

Trained researchers collected information when a stress test was ordered or performed during visits by outpatients to specific offices and hospitals.

What did the researchers find?

They found a steady increase in the use of stress tests throughout the study. Changes in patient characteristics (for example, more patients with symptoms suggesting heart blockages) and doctor characteristics contributed to the increase in testing without imaging but not the increase in testing with imaging. Also, nearly one third of imaging tests were done in patients who rarely benefit from such testing.

What were the limitations of the study?

The researchers did not have access to all clinical information, so they may have missed opportunities to classify some imaging tests as appropriate.

What are the implications of the study?

The reasons for doing multiple imaging tests are not well-understood.

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Trends in the Use of Stress Testing to Diagnose Coronary Heart Disease. Ann Intern Med. 2014;161:I–28. doi: https://doi.org/10.7326/P14-9036

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Published: Ann Intern Med. 2014;161(7):I-28.

DOI: 10.7326/P14-9036

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2014 American College of Physicians
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