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More stress tests needed before angioplasties, study says


4 Star

More stress tests needed before angioplasties, study says

Our Review Summary

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?"


Does the story adequately discuss the costs of the intervention?


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.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story could have quantified the benefit of stress testing in its ability to avoid angiography and angioplasty associated with it.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

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.

Does the story seem to grasp the quality of the evidence?


The story adequately describes the design of the current study and points out some important caveats inherent in a database-based study.

Does the story commit disease-mongering?


The story does not exagerrate the seriousness or prevalence of stable heart disease.

Does the story compare the new approach with existing alternatives?


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.

Does the story establish the true novelty of the approach?


Clearly stress testing is not a new idea.

Does the story appear to rely solely or largely on a news release?


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.

Total Score: 8 of 10 Satisfactory


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