If your doctor has been recommending a cardiac stress test, you may know that the process generally involves riding a stationary bike or walking on a treadmill until you huff and puff. But beware. An imaging technique also may be included in the stress-testing ordeal. It involves having a radioactive dye injected into your bloodstream so that scans of how the dye moves around your heart can be taken. Use of high-tech imaging is increasingly becoming the norm when it comes to cardiac stress testing. But such procedures may not always be necessary.

A recent study found that the proportion of stress tests that include imaging increased by 47% over the past 18 years. But that’s not the issue, considering that we are increasingly using technology to screen for and diagnose all types of diseases earlier and more accurately as time goes on. The problem is that at least 35% of the imaging tests used during these stress tests were probably not justified, according to the study researchers, who put the annual cost of these extra tests at $501 million and estimated that 491 future cancers would develop from the additional radiation exposure.

WHO NEEDS IT?

Imaging is most useful in people who can’t exercise on a treadmill or stationary bike but have symptoms of heart disease, such as chest pain, shortness of breath and/or palpitations, said the study’s lead researcher, Joseph Ladapo, MD, PhD, of New York University School of Medicine Center in New York City. Also, imaging is recommended as a follow-up when results taken during basic stress testing contain abnormalities that make interpreting the stress test results difficult. The imaging then helps the doctor better see what is going on. Additionally, people with diabetes or another disease that puts them at higher risk for heart disease or people with a family history of heart disease could benefit from stress testing with imaging because the imaging can confirm whether a dangerous heart situation is, in fact, brewing. So, imaging really should be reserved for cases where a heart problem needs to be confirmed, where a suspicion of a problem is high or when a regular exercise-based stress test can’t be done for one reason or another.

SHOW THEM THE MONEY

So why are doctors increasingly prescribing imaging tests for stress testing on a routine basis? One big reason is, simply, the money. Doctors are reimbursed more for tests with imaging, said Dr. Ladapo. A stress test without imaging costs between $200 and $300, whereas a test with imaging costs between $500 and $2,000.

The belief that more technology equals better care also may be to blame for the increased use of imaging during stress testing, although Dr. Ladapo said that this mind-set was more common among trainee doctors in residency programs than among long-established physicians.

As we’ve mentioned many times before, to protect yourself against unnecessary testing, ask your doctor to be very clear about why he or she is ordering the test. In terms of imaging during cardiac stress testing, ask the doctor to explain exactly why inclusion of imaging would be helpful—and how it will affect his recommendations about changes to your health regimen. If you do not fit into the categories mentioned above, you probably don’t need imaging during a stress test to evaluate heart health.