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Invasive heart test being dramatically overused, Stanford study shows
Date:4/6/2012

ogram was done a surprisingly high rate, Witteles said.

Next, they wanted to determine how high that figure was in a population of patients for whom it would almost never be medically justified to perform the procedure. So they looked at those patients who had very recently within the 30 days prior to having a coronary angiogram undergone another imaging study that would have given practitioners the same, and usually better-quality, information. (They excluded patients who had intervening diagnoses of new problems during those 30 days, such as heart failure, heart attack or shock.) Among the remaining 37,000 patients, the researchers found that not only did the majority still get the unnecessary left ventriculography procedure, but the rate actually jumped to 88 percent.

"If a patient recently had an echocardiogram or a nuclear study, it didn't make them less likely to have the left ventriculography procedure it made them more likely," Witteles said. "That is impossible to explain from a medical justification standpoint.

"It is extremely unusual, in these types of cases, to need another assessment. The only logical conclusion is that a practice pattern is being defined in which tests beget more tests, whether they're necessary or not. It would be bad enough if the figure stayed at 81 percent, but our findings showed that it went up."

Even more concerning than the added costs are the medical risks from performing an unnecessary procedure. For left ventriculography, this can include side effects from injecting contrast dye (which can be particularly harmful for patients with kidney dysfunction or diabetes), increased radiation exposure and an increased risk of abnormal heart rhythms and stroke.

During a coronary angiogram, a catheter is threaded through the blood vessels to the heart, contrast dye is inserted and X-rays are taken. The add-on left ventriculography procedure involves moving the catheter across the aortic
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Contact: Tracie White
traciew@stanford.edu
650-723-7628
Stanford University Medical Center
Source:Eurekalert

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