Study questions frequency of heart angiograms

A recent study raises questions about the frequency of doctors' use of elective heart angiograms, which showed no disease in almost 40 percent of patients. BusinessWeek reports: "Doctors may be sending patients too quickly for elective angiograms to detect heart disease, exposing them to radiation and driving up U.S. health-care costs, a study suggests. An analysis of records of about 400,000 patients concluded that 37.6 percent who underwent angiography to find obstructed heart arteries showed evidence of significant blockage, according to research published today in the New England Journal of Medicine. A total of 39.2 percent displayed none."

Researchers noted that the amount of detected disease was lower than expected and "indicates that doctors need better diagnostic tools before deciding to proceed with catheterization for angiograms, said Manesh Patel, a cardiologist at Duke University in Durham, North Carolina, and one of the authors of the study." Additionally, the study's authors said "use of medical imaging tests, including angiograms, has pushed up medical costs. They cited a federal study of Medicare that showed spending on imaging services doubled to $14 billion in 2006 from six years earlier" (Wechsler, 3/10).

The Wall Street Journal:  "More than a million U.S. patients undergo the diagnostic test each year at a cost of about $10,000 each, according to government data. In cases where significant obstruction is found, the test helps doctors determine whether a patient should undergo coronary bypass surgery or have a stent implanted to alleviate the problem. ... The study also comes amid growing concern about the exploding use of radiation-based imaging in medicine, which has sparked worries that many patients are electing to get scans that provide little benefit while increasing their risk of cancer" (Winslow, 3/11).

The Associated Press: "The researchers said the findings suggest doctors must do better in determining which patients should be subjected to the cost and risks of an angiogram. The test carries a small but real risk - less than 1 percent - of causing a stroke or heart attack, and also entails radiation exposure" (Ritter, 3/10).

Meanwhile, The Boston Globe reports on the relationship between rising health care costs and imaging tests. Massachusetts, for instance, has experienced a $214 million increase in spending on imaging tests in just two years, contributing to the rise in cost of hospital care. Researchers hired by Gov. Deval Patrick (D- Mass.) say some of the cost increase is due to the change in where imaging is done from independent clinics to hospitals, which usually cost more. Rising imaging costs are being investigated as a large reason for increased costs overall. "They found that about half of the increased spending on imaging was the result of higher prices, either hospitals charging more for the same kind of scan or substituting a more costly test, such as a CT scan, for a less expensive one, such as a standard X-ray." But some say the more expensive scans are more effective and therefore worth the cost: "there are legitimate reasons to charge more for digital mammography, including price of the machines: $350,000 to $400,0000, compared with $100,000 for traditional equipment," according to one doctor (Kowalczyk, 3/11).