Clinical guidelines from the American Heart Association and other societies recommend routine non-invasive stress testing prior to percutaneous cornonary intervention (PCI, i.e., angioplasty, with or without stenting). However, according to a new study published in this week’s Journal of the American Medical Association, stress testing was used in less than half the patients who underwent PCI in 2004. Furthermore, the rates at which stress testing was performed varied depending on geography and physician characteristics in addition to patient characteristics. These findings suggest that referral to stress testing is sub-optimal and depends – at least in part – on physician prescribing patterns that are not consistent with guidelines and evidence-based medicine.
This story does a laudable job of explaining the design of the current study and the relevance of the findings to patients. It does a good job of comparing the costs of stress testing and angiography. The story could have done more to describe the harms of stress testing and provide more information on the pros and cons of angiography versus stenting.
The story quotes multiple experts who have differing opinions on the significance of the study’s findings. The quote from Dr Gibbons sums up the issue quite well. "If everybody thinks they are providing good care, why is there such a difference between doctors?"
The story does a good job of describing the costs of angiopasty compared to a stress test. The story could have discussed out of pocket costs for patients.
The story could have quantified the benefit of stress testing in its ability to avoid angiography and angioplasty associated with it.
The story mentions missing cases of heart disease and difficulties of performing the test in older patients as potentional harms of stress testing, but there are other harms that the story should have mentioned.
The story adequately describes the design of the current study and points out some important caveats inherent in a database-based study.
The story does not exagerrate the seriousness or prevalence of stable heart disease.
The story quotes multiple sources.
The story mentions angiography as the alternative to stress testing. The story could have done more to describe the pros and cons of angiography compared to stress testing.
Clearly stress tests are available.
Clearly stress testing is not a new idea.
Because the story quotes multiple experts, the reader can assume the story did not rely on a press release as the sole source of information.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
Comments
Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.
Our Comments Policy
But before leaving a comment, please review these notes about our policy.
You are responsible for any comments you leave on this site.
This site is primarily a forum for discussion about the quality (or lack thereof) in journalism or other media messages (advertising, marketing, public relations, medical journals, etc.) It is not intended to be a forum for definitive discussions about medicine or science.
We will delete comments that include personal attacks, unfounded allegations, unverified claims, product pitches, profanity or any from anyone who does not list a full name and a functioning email address. We will also end any thread of repetitive comments. We don”t give medical advice so we won”t respond to questions asking for it.
We don”t have sufficient staffing to contact each commenter who left such a message. If you have a question about why your comment was edited or removed, you can email us at feedback@healthnewsreview.org.
There has been a recent burst of attention to troubles with many comments left on science and science news/communication websites. Read “Online science comments: trolls, trash and treasure.”
The authors of the Retraction Watch comments policy urge commenters:
We”re also concerned about anonymous comments. We ask that all commenters leave their full name and provide an actual email address in case we feel we need to contact them. We may delete any comment left by someone who does not leave their name and a legitimate email address.
And, as noted, product pitches of any sort – pushing treatments, tests, products, procedures, physicians, medical centers, books, websites – are likely to be deleted. We don”t accept advertising on this site and are not going to give it away free.
The ability to leave comments expires after a certain period of time. So you may find that you’re unable to leave a comment on an article that is more than a few months old.
You might also like