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Choosing Wisely: Tests cardiologists should avoid
The American Board of Internal Medicine’s Choosing Wisely initiative seeks to reduce unnecessary, and sometimes harmful, testing by opening up dialogue between doctors and patients.
“We believe this list will spur conversations between heart patients and their physicians to make wise decisions about care based on their individual situation,” James C. Blankenship, MD, FSCAI, vice president of the Society for Cardiovascular Angiography and Interventions (SCAI), said in a press release.
“We need to discuss openly the ill effects of a false-positive test, unnecessary invasive testing, anxiety for the patient, postponement of procedure and, of course, cost,” Sangeeta Shah, MD, FACC, FASE, division director, Cardiovascular MRI at the John Ochsner Heart and Vascular Institute, said in written comments to Cardiology Today.
Shah said ordering certain tests may have an effect on the perceived quality of care in the patient’s eyes.
“One of the cardiology cultures in doctor-patient relationships is an unspoken expectation that a test is necessary to see if the heart is working properly,” he said. “The test is performed as a reassurance to the patient.” Shah added that if a test is not ordered, the patient may not think highly of their doctor.
“The Choosing Wisely initiative takes the opportunity to start a dialogue amongst doctors and patients on the importance of choosing the appropriate test, if necessary, with maximum benefit to the patient, while taking into consideration the risk and cost,” Shah wrote.
Many medical societies have published their own list of five or more tests to avoid.
Choosing Wisely guidelines related to cardiology, as well as resources to share with patients, are available at these links:
- American College of Cardiology
- American Society of Echocardiography
- American Society of Nuclear Cardiology
- Heart Rhythm Society
- Society for Cardiovascular Angiography and Interventions
- Society of Cardiovascular Computed Tomography
ABIM has also published resources for patients regarding screening procedures to aid in discussions with physicians.
- Chest X-rays before surgery: When you need them
- Choosing pain relievers with kidney disease/heart problems
- Echocardiography for heart valve disease
- EKGs and exercise stress tests: When you need them
- Heart imaging before surgery: When you need them
- Heart tests before surgery: When you need an imaging test
- Imaging stress tests: When you need them
- Imaging tests after a heart procedure: When you need them
- Imaging tests for heart disease: When you need them
- Stress tests for chest pain: When you need an imaging test
- Testing after heart procedures: When you need a nuclear stress test
- Treating blocked leg arteries: When you need a procedure
Nine medical societies issued guidelines when Choosing Wisely was launched. Currently, over 40 societies and associations have developed guidelines.
Richard J. Baron
“When the Choosing Wisely campaign was launched in 2012, we were at the threshold of a national dialogue on waste and overuse in our health care system,” Richard J. Baron, MD, president and CEO of the ABIM Foundation, said in a press release.
“Thanks to the leadership of physician groups and consumer partners, the campaign has inspired conversations about what care is truly necessary in doctors’ offices, communities, hospitals and health systems across the country.”
Shah said he believes the guidelines are very useful.
“We, as physicians, need to avoid testing as a reassurance tool, have an honest discussion and provide patients with Choosing Wisely resources when patients request unnecessary testing.”