Cardiac stress testing may not benefit emergency department patients with chest pain
Patients seen in the emergency department (ED) for chest pain who did not have a heart attack were found to be at very low risk of experiencing a heart attack during 190 days of follow-up. Early cardiac stress testing compared to no stress testing was not associated with lower odds of having a heart attack in the future. Penn State Hershey's Dr. Andrew J. Foy and co-authors report their findings in a paper published online by JAMA Internal Medicine.
About 6 million patients are seen in EDs annually for chest pain or other symptoms suggestive of myocardial ischemia (decreased blood flow to the heart). Patients without objective evidence of myocardial ischemia have been found to be at low risk for experiencing a major cardiovascular event during short term follow-up, and most patients do not have a cardiac cause for their symptoms. Cardiac stress testing is commonly performed in these patients to delineate those who may benefit from more aggressive therapy. However, there is little evidence that cardiac stress testing in these patients is beneficial.
The researchers compared ED patients with chest pain who underwent early cardiac stress testing with those who did not. The study analyzed health insurance claims data for a national sample of privately insured patients during the year 2011.
The study found that the percentage of patients who were hospitalized with heart attack during 7 and 190-days of follow-up was 0.11 percent and 0.33 percent, respectively. Early cardiac stress testing compared to no stress testing was not associated with lower odds of having a heart attack in the future. However, it was associated with more downstream testing and invasive treatment. Ultimately, this challenges the current belief in the field that cardiac stress testing in this patient population can prevent future heart attacks. Rather, it would appear that it only increases unnecessary downstream testing and invasive treatment.
“More studies need to be conducted to clarify the best testing strategy for low-risk patients being evaluated for chest pain in the ED,” Foy said. “Given today's concerns regarding health care cost growth, especially the portion attributable to noninvasive cardiac imaging, and patient safety issues related to radiation exposure as well as overdiagnosis, performing such a study should be a priority.”
National Institutes of Health funded this study.
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