Cardiac Stress Tests: Who Needs Them and When

As physicians, our goal is to give you the best care possible, but a recent study published in the Annals of Internal Medicine suggests that many doctors may be over testing patients.

Researchers looked at stress EKGs and stress ECHOs, which examine the motion of your heart when you’re active, to better understand whether using these tests for screening purposes was the most effective approach for patient care. They also looked at resting EKGs and nuclear stress tests, which examine heart rhythm and blood flow during rest and activity. Researchers found that many doctors ordered these tests unnecessarily in patients who were low risk with no symptoms.

Who Should Get a Cardiac Stress Test

Cardiac stress tests can be very valuable diagnostic tools in the right situation with the right patient. The study, which looked at a large database of information, shows just how important it is for doctors to make evidence-based recommendations. To be clear, EKGs and stress tests are 100 percent necessary in high-risk patients who display symptoms that could indicate a cardiac event such as a heart attack.

We’ve all heard the phrase “better safe than sorry,” but giving low-risk patients unnecessary tests can be harmful. Cardiac stress tests in and of themselves aren’t harmful, but some follow-up tests may come with risks such as more exposure to radiation and negative reactions in certain patients. False positives also can lead to procedures that some people may not need, like a cardiac catheterization, which is complicated, costly and comes with its own set of risks. In these situations, one unnecessary test may warrant further unnecessary testing that could harm the patient.

When to Get Tested

Ask your doctor what risk factors you have that may have prompted him or her to move forward with testing. Once you have an understanding of your risk factors, have a discussion with your doctor about whether you have symptoms that warrant certain tests. If you don’t, then a screening test may not be necessary.

If you have high cholesterol, diabetes, are overweight, smoke or have a family history of heart disease, changing your lifestyle, following a healthy diet and losing weight can significantly improve your heart health. Screening exists for a reason, but focusing on prevention and practicing heart-healthy habits day in and day out are the best ways to ensure you never need these tests in the first place.

Some doctors believe the benefits of screening outweigh the potential harms, but as a patient you shouldn’t have to undergo tests unless they are absolutely medically necessary. You should work with your doctor to manage your risk factors to reduce the possibility of a cardiac event.