Dr. Grace Lin of the University of California, San Francisco, whose study appears in the Journal of the American Medical Association said, "It's important to document that patients are receiving PCI for appropriate indications to ensure the optimal use of Medicare resources."
More than 800,000 PCI procedures are performed each year and each procedure has contributed significantly to increase in Medicare spending since the mid-1990s. The research showed the number that received the procedure to be just 44 %. "We didn't expect to find 100 percent, but we expected a much higher percentage than 44," said Dr. Rita F. Redberg, professor of medicine at the University of California, San Francisco.
Typically done on a treadmill, stress tests, can show whether a person has ischemia, or inadequate supply of blood to the heart caused by a blocked artery. "What really matters is whether or not that blockage is affecting blood flow to the heart. That is why the stress test is important," Lin said.
Earlier studies have said that many stable patients with chest pain can get similar relief with standard drug therapy at far lower cost. Lin and colleagues studied insurance claims in 2004 from Medicare beneficiaries and found only 44 % took a stress test 90 days prior to elective surgery. "There was a tremendous amount of variation in the amount of stress testing that was done," Lin said. The Society for Cardiovascular Angiography and Interventions said the results though important were not accurate as stress tests are not always appropriate, especially for patients who are too sick or immobile to take them.
Stress tests should be done regularly, not just when angioplasty is being considered, said Dr. Eric Topol, director of the Scripps Translational Science Institute in La Jolla, Calif. "Then you have a way to follow a patient," he said. "You can do a stress test every year to be sure things are normal. That is an important baseline that is being ignored all too frequently."
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