Feature | April 01, 2013

Stress Echo May Be Overused, Leading to False Patient Diagnoses

The American Society of Echocardiography lists five things physicians and patients should question

February 21, 2013 — The American Society of Echocardiography (ASE) has released a list of five interventions whose appropriateness physicians and patients should discuss as part of Choosing Wisely, an initiative of the ABIM Foundation, along with Consumer Reports. Fourth in the list, they ask that patients and their doctors talk about the real need for a stress echocardiogram if they do not present conditions that would warn them of a risk of heart disease.

Avoid using stress echocardiograms on asymptomatic patients who meet “low-risk” scoring criteria for coronary disease.

Prior to ordering or undergoing a stress echocardiogram a patient’s risk factors and symptoms should be carefully assessed. The presence of risk factors for heart disease and/or symptoms suggestive of coronary artery disease improves the chance that an abnormal test will reflect true disease in the heart.

Stress testing is performed to determine whether or not there are blockages in the arteries of the heart and whether or not the blockages are severe enough to affect blood flow to the heart. During a stress echocardiogram the heart is challenged either by exposure to exercise or to medications that can simulate the work of exercise. Echo pictures are taken at rest and then following the stress component of the test. Using echo, the presence of a significant blockage causing wall motion abnormalities can be readily identified by evaluating the pumping of the heart muscle. A positive test is a marker of an increased risk of adverse heart events and often leads to further testing such as a cardiac catheterization or aggressive use of medications.

Because of the potential implications of a diagnosis of heart disease, it is important to make sure that the results of the test are accurate. Performing the test in individuals who have some risk for heart disease increases the chances that a positive represents true disease. Risk factors for coronary artery disease, using the scoring mechanism common in patient heart evaluations, include cigarette smoking, high blood pressure, high cholesterol, positive family history of heart artery disease, obesity, inactivity, diabetes mellitus and peripheral vascular disease. Having one or more of these factors increases the likelihood that chest pain actually represents underlying heart artery disease. Symptoms suggestive of heart artery disease include pressure/pain in the mid-chest that occurs with exertion. The discomfort can also spread to the arms, back, neck or jaw, and can be associated with shortness of breath.

Individuals without these symptoms or risk factors for heart disease are less likely to have heart artery blockages and should not undergo surveillance stress echocardiography or any other stress test due to the risk of obtaining a falsely positive test.

The goal of Choosing Wisely is to promote conversations between physicians and patients about utilizing the most appropriate tests and treatments and avoiding care that may provide no benefit.

ASE’s testing cardiovascular care scenarios were chosen based on the highest likelihood of improving patient care and reducing inappropriate test use. Leaders in the organization transformed the scenarios into plain language and produced the clinical explanations for each procedure. In particular, ASE’s cardiovascular care experts, reviewed the ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriateness UseCriteria for Echocardiography (AUC), which was published in March 2011.

ASE encourages all medical professionals engaged in cardiovascular care to read the “Five Things Physicians and Patients Should Question” and to engage patients in conversations about reducing inappropriate tests and procedures with a goal of improving care and avoiding harm.

Consumer Reports, along with a coalition of consumer partner organizations, is also a part of the Choosing Wisely effort and is working with many of the societies to help patients understand the tests and treatments that are right for them.

For more information: www.asecho.org, www.choosingwisely.org

Related Content

Sponsored Content | Videos | Cardiovascular Ultrasound| June 28, 2016
Interview with Rebecca Hahn, M.D., FASE, Columbia University Medical Center, is an expert in the new subspecialty of
Epsilon Imaging, EchoInsight, left ventricle, LV measurement, strain imaging, ASE 2016
News | Cardiovascular Ultrasound| June 17, 2016
Epsilon Imaging Inc. announced a research study was presented at the American Society of Echocardiography (ASE) 2016...
ZOOM+Imaging, on-demand service, X-ray, ultrasound, CT
News | Business| June 15, 2016
ZOOM+ announced the launch of ZOOM+Imaging, a proprietary digital platform for on-demand scheduling, paying and sharing...
hypertrophic cardiomyopathy, HCM, strain echocardiography, risk assessment, ASE 2016
News | Cardiovascular Ultrasound| June 13, 2016
After following a large sub-set of patients, researchers found that by using strain echocardiography they could...
ASE 2016, Mayo Clinic study, echocardiography, aortic flow rate, patient risk stratification
News | Cardiovascular Ultrasound| June 13, 2016
Researchers from Mayo Clinic believe they have found a better way to risk stratify some of their most fragile patients.
ASE 2016, echocardiography, telemedicine, Arkansas, pediatric patients
News | Telecardiology| June 13, 2016
Two new research studies verify that echocardiography, linked to experts through telemedicine, can provide better and...
cardiac ultrasound, ASE, American society of echo
News | Cardiovascular Ultrasound| June 09, 2016
Below is a roundup of recent echo news that highlights technologies and topics that will be featured at the American
TeleHealthRobotics, Tele-Robotic Ultrasound, TRUDI, robotic ultrasound

The Tele-Robotic Ultrasound for Distance Imaging (TRUDI) system uses a robotic arm so a remote sonographer can control the echo probe without the need for them to be in the same room or even be in the hospital during an exam or procedure. 

News | Cardiovascular Ultrasound| June 09, 2016
June 9, 2016 — The American Society of Echocardiography (ASE) will host Echovation Challenge 2016, a competition for
ASE 2016, echocardiography, Seattle
News | Cardiovascular Ultrasound| June 01, 2016
The American Society of Echocardiography (ASE) will host its 27th Annual Scientific Sessions, June 10-14, 2016, at the...
Technology | Cardiac Imaging| May 18, 2016
May 18, 2016 — The Intersocietal Accreditation Commission (IAC) recently announced its launch of the IAC QI Self-Asse
Overlay Init