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.