This story explores the influence of computed tomography (CT) scans of blood flow in the heart on symptoms and quality of life of chest pain patients. The story makes clear that the benefits vary, with the most benefit going to those patients who are either told they can stop medical treatment or that there is effective treatment for them. Patients who discovered their disease was worse than they had believed fared worse after they received the scans.
Readers get a sense that the decision to add computed tomography coronary angiography (CTCA) — a high-resolution X-ray of the heart — to their diagnostic process should be approached individually. The value of this nuanced description of the study results is undercut, however, by a lack of context. Readers are not given any background about other approaches to managing anxiety and uncertainty in patients with chest pain. The story fails to note costs of the test and the study limitations that researchers listed in their journal article. The article also omitted one of the downsides of screening tests: the potential for over-diagnosis leading to unnecessary, stress-producing follow-up tests.
Tests can open a cans of worms, sending patients into further testing and treatment, in addition to presenting direct harms (such as radiation exposure in the case of CTCA). Stories about testing need to clearly convey the problems that testing can create, so that readers understand that decisions about getting a test are almost never simple. By laying out scenarios in which CTCA either offered no benefit or actually seemed to lead to patients feeling worse about their situations, in addition to the types of cases in which patients appeared to benefit, this story portrays some of the pros and cons that patients and providers should consider.
The story does not mention the cost of computed tomography coronary angiography (CTCA), which can be a few hundred dollars.
This story is about how patients felt and the symptoms they reported, not purely medical outcomes. It notes that the benefits vary from person to person and makes no claim of dramatic benefits. But we’d like to see the claim that was made backed by some numbers. It says “… patients’ quality of life got worse in the following weeks and months.” How much worse?
The story includes a cautionary quote about the type of patient who might end up feeling worse after CTCA testing. The story would have been better if it noted that this type of scan can inadvertently find suspicious shadows, especially in the lungs, which may then lead the patient into further, possibly invasive, testing. The story could have also included some reference to concern about harms from X-ray radiation.
The journal article clearly listed limitations of the study, but the story does not mention these limitations. For example, there was no information on the psychological status of the patients, which could be relevant to any consideration of symptoms and quality of life. The story also does not point out that the research did not look at any alternative methods for clarifying this sort of chest pain diagnosis or ways to manage uncertainty or anxiety.
The published study said the CTCA group was compared to standard of care and that 85% of the comparison group had exercise stress tests. That might have been useful background to include.
The story reports that the researchers were looking at CTCA testing only for specific patients who had already been given a diagnosis related to chest pain. Readers would likely understand that the CTCA test was being offered only to certain patients to clarify their diagnoses, not something that would be recommended to people who were not already being tested or treated for chest pain that might be caused by heart disease. The article might have added a bit more clarification on who the test was intended to help.
There is an independent source quoted. However, the story does not mention that the senior researcher quoted throughout the story had disclosed “honoraria and consultancy from Toshiba Medical Systems,” a manufacturer of CT scanners. There is also no mention of the funding of the study, though the funding description in the journal article says it came from a mix of public agencies and foundations, not from an industry source.
The story could have used some additional context. Since the main concerns were how patients felt, including their desire for certainty and reassurance, it seems that the story could have addressed counseling and other ways that patients could gain a sense of control or acceptance of their health situations. A stress test is an equally valid, and in many cases, may be a better way to assess the arteries of the heart.
The story refers to CTCA as an available testing method.
The story appropriately characterizes the research as providing new data on how patients feel, their symptoms and quality of life, depending on whether or not CTCA was used to further clarify their chest pain diagnoses. It does not claim that CTCA is itself new. It would have been nice to see some reference to other research into the quality of life of chest pain patients, especially whether counseling or the ways doctors communicate with patients have an effect on these measures.
The story includes interview quotes from two sources and does not appear to rely on a news release. No news release about this study was found online.