In the spring of 2008, NBC’s Meet the Press moderator and Washington bureau chief, Tim Russert, died suddenly of a heart attack at the age of fifty-eight. Time magazine identified him as one of the one hundred most influential people in world in 2008. His ability to make complex topics clear for the public and to ask the hard questions will be missed.
Perhaps more shocking was that just a few weeks earlier, he had passed a cardiac stress test.
In other words, the stress test was normal.
This is one of the biggest myths that must be dispelled about screening for heart disease. In patients with no symptoms, screening for heart disease with heart stress tests such as treadmills or using EKGs has not been shown to save lives. These tests are far more beneficial in evaluating patients with symptoms of chest pain, shortness of breath, palpitations, or other symptoms that might be related to the heart. Yet this message is not being heard. A 2011 article from Consumer Reports found in a survey of over eight thousand subscribers between the ages of forty and sixty who had no history or symptoms of heart disease that about half had undergone an EKG and one out of five had taken a heart stress test.
In patients at little to low risk for heart disease, an EKG or stress testing can actually lead to harm. The heart stress test can be a false positive; that is, the test can detect an abnormality which then has to be further investigated with either a nuclear medicine scan or a CT angiogram, both of which require radiation exposure. In patients at little to low risk, the subsequent results are normal, as one would expect. The patient went through unnecessary worry and testing. There can be too much of a good thing.
In the case of Mr. Russert, who was at higher risk of heart disease due to his age, gender, and other risk factors, passing a cardiac stress test also shows the limitation of these tools. They do not work well in predicting the risk of heart attack in patients with no symptoms. Be aware of this limitation before someone recommends this type of testing, particularly when you feel well.
Consumer Reports has an excellent app that helps you determine which interventions are best in screening for heart disease.
The boring, unsexy task of controlling cholesterol and high blood pressure were rated the best and highest. The benefits far outweighed any of the risks. One of the worst interventions, where the risk outweighed the benefit? The heart stress test.
As you pay more out of pocket for health care, isn’t important to know what is and what isn’t worth your hard-earned money?
Davis Liu is a family physician who blogs at Saving Money and Surviving the Healthcare Crisis and is the author of The Thrifty Patient – Vital Insider Tips for Saving Money and Staying Healthy and Stay Healthy, Live Longer, Spend Wisely.