Unneeded heart screenings are being given to many healthy adults

by Terry A. Rondberg, DC

Posted April 14, 2011

A large-scale survey conducted by Consumer Reports Health found that 44% of healthy adults were given unnecessary – and often expensive – cardiac screening tests such as an electrocardiogram (EKG), a blood test for C-reactive protein (CRP), and an exercise stress test. The patients had normal blood pressure and cholesterol levels, no risk factors, and no history of heart problems.

“Something needs to be done to rein in the spending and testing spree by patients and their doctors. It’s worrisome that healthy people are getting tests they may not need because a prevention test that is not reliable can lead to a cascade of unnecessary, costly, and in some cases risky follow-up tests and treatment,” said John Santa, MD, MPH, director, Consumer Reports Health Ratings Center. Consumer Reports Health is a segment of Consumer Health Union that investigates and reports on a variety of health products and services.

For most adults who have no risk factors, these tests are not recommended since, as Dr. Santa noted, “All of these tests carry moderate risks to this group and therefore we would advise against them because they can do more harm than good.”

In addition, the high frequency of false positives for many tests leads to unneeded stress and additional expense for still more tests.

Sadly, many people seem to be conditioned to believe all tests are good. According to the survey, the overwhelming majority of survey respondents (87%) said they completely or somewhat agreed that “it’s better to have a scare that turns out to be nothing than to not get tested at all.” Only 18% recognized the downside of testing, saying they completely or somewhat agreed that the risk of a false positive was too great. These findings suggest that consumers may not see the harm that could come from overtesting.

Some examples of heart screenings deemed unneeded for most healthy individuals include electrocardiograms (EKG), which were administered to 39% of healthy adults, the C-reactive protein (CRP) blood test (37%), and an exercise stress test (12%).

The survey also indicated that most patients are not given enough information by their physician to make informed decisions about the tests. For example, only 11% of healthy adults had a conversation with their doctor about the type of follow up that would be necessary if the test detected an abnormality. A paltry 9% discussed the accuracy of the test and 4% knew about potential complications that could arise as a result of the test. Only 1% discussed with their doctor whether or not the medical evidence had shown that the test could save lives.

The medical profession has been accused before of performing too many unnecessary tests. A study was conducted in 2006 by researchers from Georgetown University Medical Center and Johns Hopkins University, and published in the June 2006 issue of the American Journal of Preventive Medicine.

That study focused on three tests that presented risks outweighing the benefits, as judged by a panel of experts for the United States Preventive Services Task Force: EEK or electrocardiogram, urinalysis, and chest X-ray. At least one of these procedures – dubbed class “D” tests – was ordered 43-46% of the time, the researchers said.

Using extrapolation techniques, the researchers determined that direct medical costs for the three "D" tests ranged from $47-194 million. Adding in two other tests from the "C" category (those which the panel made no recommendations for) pushed the costs up by another $12-63 million.

"These types of massive screening activities are not very cost-effective generally," stated Greg Scandlen, founder of Consumers for Health Care Choices. "If a patient is in an at-risk group, then this kind of screening is appropriate, but the cost of doing it to large numbers of people just to find a tiny fraction of people with a problem is not justified," he added.

SOURCES: “44 Percent of Healthy Adults Getting Unneeded Heart Screenings,” Consumer Reports Health, news release 02/03/2011

“Millions Squandered in Unnecessary Tests Ordered in Routine Doctor Visits,” Georgetown University news release May 19, 2006

(Dr. Terry A. Rondberg is founder and CEO of the World Chiropractic Alliance and publisher of The Chiropractic Journal. His reports on other health and wellness news appear on www.TerryARondberg.com and www.TerryRondberg.com.)