Growing Use of Cardiac Stress Testing in the U.S.

Allan S. Brett, MD

For patients without known coronary disease, stress testing with imaging has increased considerably during the past 2 decades.

Concern has been growing that cardiac stress testing — especially with imaging — often is performed unnecessarily. Researchers used data from U.S. national ambulatory surveys to track trends in use of these procedures between 1993 and 2010 among patients without known coronary disease.

During this 18-year period, the average rate of stress testing overall increased from 28 tests to 48 tests per 10,000 outpatient visits. The proportion of stress tests done with imaging (either nuclear or echocardiographic) increased from 59% to 87%. Applying multisociety appropriateness guidelines to testing performed between 2005 and 2010, the researchers estimated that 14% of stress tests without imaging and 30% of tests with imaging would be “rarely appropriate.” More frequent stress testing was not associated with any particular patient or provider characteristics or specific patient risk factors.

Citation(s):

Ladapo JA et al. Physician decision making and trends in the use of cardiac stress testing in the United States: An analysis of repeated cross-sectional data. Ann Intern Med 2014 Oct 7; 161:482.