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Calcium scores and heart disease

Rating

2 Star

Calcium scores and heart disease

Our Review Summary

This is a story about a method of screening for heart disease.  Though the story mentioned that there are some experts who believe that the test is being overused, there was no direct comment about this to explain why overuse of a test is problematic.

The story did mention that the test was for individuals who were at high risk, though it did not explicitly define what would put someone at high risk. 

The story did not provide insight into the evidence about the impact of coronary artery calcium on the risk of heart disease. It did not present information about the magnitude of benefit that might be attained with this test. Although there was some discussion about whether the test is used too often, there was little mention of the population for whom the test might provide useful insight about an elevated risk.  The story failed to mention an estimate of how much an elevated calcium score affects risk, for example, of having a heart attack or sudden cardiac death.

There was no discussion about the harms of treatment. This test does expose the patient to a small amount of radiation.  It would be suggested that a woman who is pregnant or might be pregnant be sure to discuss this prior to the test. There is a chance that the test might appear positive even though there are no blockages of coronary arteries.  As a result, the person might have additional testing that is unnecessary and that carries its own potential risks and side effects.  Additionally – there may also be the harm of incidental non-cardiac findings.

The story did not put the new test into the context of existing tests. 

The story would have had greater integrity had it included a statement from independent experts who no ties to the procedure or the hardware investment at their own facility.

 

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

A graphic was presented of the average cost being $300 – $400 for the test. However – this does not include the cost of any testing that might follow (including heart catheterization)

It would have been useful to provide information as to whether this test was or was not commonly paid for by insurance companies.

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

Not Satisfactory

This story did not present information about the magnitude of benefit that might be attained with this test. Although there was some discussion about whether the test is used too often, there was little mention of the population for whom the test might provide useful insight about an elevated risk.  The story failed to mention an estimate of how much an elevated calcium score affects risk, for example, of having a heart attack or sudden cardiac death.

 

 

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

Not Satisfactory

There was no discussion about the harms of treatment. 

This test does expose the patient to a small amount of radiation.  It would be suggested that a woman who is pregnant or might be pregnant be sure to discuss this prior to the test. There is a chance that the test might appear positive even though there are no blockages of coronary arteries.  As a result, the person might have additional testing that is unnecessary and that carries its own potential risks and side effects.  Additionally – there may also be the harm of incidental non-cardiac findings.

 

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

Not Satisfactory

The story did not provide insight into the evidence about the impact of coronary artery calcium on the risk of heart disease. 

The story began by saying that it is "a new tool for patients to fight off heart disease".  This is actually a misrepresentation because it is simply a diagnostic measure and does nothing to prevent or treat heart disease. 

 

Does the story commit disease-mongering?

Satisfactory

It almost sounded like disease mongering – "Manuel Paz is the picture of health on the outside…."  but in the end, he not only was the picture of health on the outside, but the scan showed nothing to confound this image.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

Several clinicians involved in providing CT calcium screening were interviewed as a part of this story.  But they were both from the same medical center and both appeared to have interests in the CT screening facility at their institution.

The story would have had greater integrity had it included a statement from independent experts who no ties to the procedure or the hardware investment at their own facility. 

Does the story compare the new approach with existing alternatives?

Not Satisfactory

Although the story mentions that the healthy appearing man who was having the scan had high cholesterol and a family history of early heart disease, and mentioned at the end that there is some concern that the test is being overused, the story failed to define in a meaningful way, for whom this test would be appropriate.

Young individuals for whom there are not other known risk factors of heart disease are not likely to benefit from this test.  The test is also not likely to be useful to older individuals who would likely not be treated differently based on the results. 

The story did not put the new test into the context of existing tests.  

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

Although mentioned as a 'new tool', the story did not provide any information about availability of this test.

Does the story establish the true novelty of the approach?

Satisfactory

The story reported on a screening tool for cardiac disease that is relatively new.

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

Not Applicable

We can't be sure if the story relied solely or largely on a news release, although it did rely on input from only one medical center. 

Total Score: 3 of 9 Satisfactory

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