Use of non-indicated cardiac testing in low-risk patients: Choosing Wisely

BMJ Quality & Safety
August 2014
Colla, C.H., Sequist, T.D., Rosenthal, M.B., Schpero, W.L., Gottlieb, D.J., and Morden, N.E.

In 2011, the American Board of Internal Medicine Foundation created the Choosing Wisely initiative, which encourages physicians to be responsible stewards of finite healthcare resources. Drawing on HCFO-funded work, this article estimates the proportion of low-risk Medicare beneficiaries receiving non-invasive cardiac screening tests without a clear, pertinent symptomatic indication, as well as the regional variation in and spending associated with these tests. This study builds on previous efforts to understand overall testing prevalence and testing among high-risk patients, inappropriate use of particular advanced imaging modalities, and regional variation in cardiologists’ propensity to test and treat. The researchers found that low-value testing in the low-risk cohort was the least common in the central and north-western parts of the USA. Their results also showed that the strong association between potentially non-indicated cardiac testing in low-risk groups and cardiac testing in high-risk groups demonstrates that some physicians use more cardiac tests regardless of the clinical scenario. This study highlights the need for an evidence-based approach to risk stratification, screening indications and ideally a consensus definition for non-indicated tests.

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