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  • Cameron Oglesby

7 cardiac procedures you might be better off skipping




During the almost half-century since stress EKGs earned clinical acceptance, many additional procedures have become standard procedures for diagnosing and treating cardiovascular problems. Now, two respected authorities – the American Heart Association and the American College of Cardiology – suggest that those procedures have become a bit too standard.


About half of all Americans undergo at least one such test each year, the AHA reports. But while there’s nothing wrong with the procedures themselves, doctors should use them less universally and more selectively. Some doctors recommend them routinely, out of force of habit or because they haven’t kept up with the latest best practices. Others recommend them defensively, either to leave no stone unturned or to protect themselves from possible malpractice complaints.


But overuse, the AHA reports, can often be of little benefit to many patients. Moreover, it can “creat[e] risk of avoidable complications from subsequent cascades of care and excess costs.”


Here are some examples of cardiac procedures tat some patients should undergo and others might be better off skipping:


1. Stress testing or advanced cardiac imaging in initial patient evaluation: If you’re over 40, have chest pain or other symptoms, or high risk markers such as peripheral arterial disease or diabetes, this screening can be very beneficial. But, says the American College of Cardiology, 45% of patients – those with low cardiac risks and no symptoms – get tested unnecessarily.

2. Routine annual stress testing or CT or invasive coronary angiography after a bypass or stent: If it’s more than five years after a bypass or 2 years after a stent, you should get tested. If not, and you have no or stable symptoms, you expose yourself to excess radiation and unnecessary invasive follow-up procedures.

3. Pre-operative EKGs, stress testing, coronary calcium scoring, or advanced cardiac imaging in preparation for low-risk, non-cardiac surgery: Cataract removal, endoscopy, and many other surgeries carry less than 1% risk of heart attacks or death. The test results won’t change your care or outcome. So you should really consider skipping them.

4. Echocardiography for patients with syncope. Syncope is passing out from low blood pressure. If you don’t have cardiac disease symptoms, you can probably do without it, the AHA says. But if you also have a heart murmur, you should get the echocardiograph.

5. Yearly follow-up echocardiography for mild native valve disease with no (or stable) symptoms: “Patients with native valve disease usually have years without symptoms before the onset of deterioration,” the American College of Cardiology advises. So you might want to hold off until something in your condition changes.

6. High-sensitivity troponin testing: Troponins are proteins that regulate heart muscle contraction. Normally they’re almost undetectable in your blood; that’s why testing for them is highly sensitive. Damage to heart muscles, as from a heart attack, releases more troponins into the bloodstream – in which case troponin levels become elevated within three or four hours and remain elevated for up to 14 days. If you have acute chest, jaw, neck, or shoulder pain; shortness of breath; or worsening angina, you should get tested right away. But without those symptoms, and with low cardiac risk, you might not need to.

7. Coronary calcium scanning can help your doctor determine whether there’s calcium buildup in your arteries and you need to start taking statins. If you already take statins for high cholesterol, or you’re already known to have blockages, it doesn’t help much.


Whether or not to undergo a specific procedure is, obviously, not a decision you should make on your own. Nor is it one that your doctor should make unilaterally. So if your doctor recommends a test or procedure, you (or your health advocate) should always feel free to ask why, and what the alternatives and options are.


There’s a similar problem with senior care. It’s all too easy to get sold on more care than is needed – or at a higher level than needed – because that’s all the caregiving company offers. Unlike overuse of marginally beneficial medical procedures, overcare won’t damage tour health. But it can eat into the client’s financial reserves and sense of independence.


That’s why, before Senior Insights recommends any type of care, we conduct a thorough three-part needs assessment of our clients’ physical, cognitive, emotional, and psychosocial health, along with their and their families’ preferences and priorities. That way, we can design a holistic senior management program that incorporates the lowest amount and level of care consistent with the client’s health, sense of well-being, financial resources, and continued independence.


Please contact us to learn more about what a difference that can make.


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