Do You Really Need a Stress Test? They’re Not for Everyone

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Many patients who are at low risk for heart problems don’t need screenings such as electrocardiography (EKG) and stress tests, a national association of primary care physicians recently recommended.

The American College of Physicians (ACP) released guidelines recently that say that there is no evidence that these types of screenings benefit people with low risk.

You might be considered low-risk for coronary heart disease if you’re young, do not have a family history of early heart disease, are physically active and eat a healthy diet.

Needless screening

Coronary heart disease is the single leading cause of death in the United States. But the benefits of cardiac screening in low-risk adults have long been questioned, the ACP researchers say.

The new guidelines are in line with research that indicates stress tests often are performed on patients who don’t really need them.

Stress tests are best used when all information about a patient is considered, says cardiologist Curtis Rimmerman, MD.  If no additional risk factors are present, a stress test may not be necessary, Dr. Rimmerman says.

“The stress test has to be applied within the context of the patient and looking at the entire patient: their risk factor profile, their symptoms, their age and their activity level, among other information,” Dr. Rimmerman says.

A time and a place

The danger with unnecessary stress tests is that they can result in false-positives, which are results indicating a problem that does not actually exist, Dr. Rimmerman says. That can lead to more testing that is not needed or can be risky and more complicated, Dr. Rimmerman says.

Risks from the screening tests themselves include exposure to radiation, a bad reaction to an injection, or problems during exercise, the ACP says.

For patients, follow-up testing and procedures can cause anxiety and take time away from work or family.

“There is a time and a place for necessary testing,” Dr. Rimmerman says. “This is a best-practice issue and, especially, an issue of what is in the best interests of the patient.”

Symptoms that may indicate a need for a stress test could include shortness of breath with exertion or discomfort in the chest and other areas of the body, says cardiologist Vladimir Vekstein, MD. This is especially true for women.

“A stress test is called for when the patient reports atypical symptoms, particularly patients with diabetes and family history of premature coronary artery disease,” Dr. Vekstein says.

The complete statement from the ACP appears online in the journal Annals of Internal Medicine.

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