Living with heart disease? Avoid unnecessary testing

Medical tests are an important part of managing chronic health problems such as cardiovascular disease. Some, like checking blood pressure or cholesterol levels, are fairly simple and straightforward. But others (especially those that use special equipment to visualize the heart) are time-consuming, stressful, and costly — and in some cases, unnecessary.

It's not uncommon for people with known chronic coronary disease (see "What is chronic coronary disease?") to undergo such imaging tests on a routine basis, even when they don't have any symptoms to suggest that their condition is progressing or worsening. Now, new guidelines recommend against this practice.

"People with established coronary disease who don't have symptoms shouldn't be undergoing tests on a periodic basis," says Dr. Dhruv Kazi, who directs the Cardiac Critical Care Unit at Harvard-affiliated Beth Israel Deaconess Hospital. The guidelines, published Aug. 29, 2023, in the journal Circulation, say that for those people, there is no benefit for the following three tests:

Cardiac CT angiography (CCTA) uses a CT scanner to take multiple, high-speed x-rays to create three-dimensional views of the blood vessels and other heart structures. It requires an injection of special dye into a vein in the arm or hand that "lights up" the blood vessels.

Echocardiography uses ultrasound to show how well the heart's muscles and valves are working and to measure the ejection fraction, an assessment of the heart's pumping ability.

Stress testing monitors your blood pressure, your heart rate, and your heart's electrical activity to check for evidence of decreased blood flow to the heart, either during exercise or after an injection of a drug that mimics the effects of exercise. It may also involve getting an echocardiogram (a variation called stress echocardiography) or an injection of a small amount of a radioactive substance and a PET scan (a variation known as a nuclear stress test).

No help, possible harm

When people without symptoms get testing "just to be sure," the results are unhelpful — and in some cases harmful, says Dr. Kazi, who was on the writing committee for the new guidelines. For example, if test results aren't clear, that often generates additional testing or unnecessary procedures, including some that expose people to radiation for no reason. These tests add expense without any corresponding benefit, and the costs are increasingly being passed back to patients, in the form of copayments or higher premiums, he adds.

For people with chronic coronary disease, the real bang for the buck lies elsewhere, says Dr. Kazi. "As the guidelines emphasize, people should focus on getting regular exercise, eating a healthy diet, and taking medications to control their blood pressure and cholesterol — all strategies that we know help people live longer, healthier lives," he says.

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