Are all those heart tests really necessary?

It’s a case where an ounce of prevention might end up doing more harm than good.

That’s what a surprising new report by the American College of Physicians says about having your heart tested when you have no symptoms of anything being wrong with it.

Cardiac screening in adults at low risk for heart disease is what ACP President Dr. David Fleming called “low-value care” since “it does not improve patient outcomes and it can lead to potential harms.”

Instead, the ACP is advising doctors do an assessment of individual risk factors. Patients found to be at low risk, it says, should not be given electrocardiograms or other heart tests.

“Even ‘baseline’ ECGs are rarely helpful,” Dr. Fleming cautioned.  A false positive, for example, “may result in unnecessary tests and treatments with their own additional risks.” And “the harms of radiation exposure may not be seen for years.”

Instead, the ACP suggests that low-risk patients be encouraged to take preventive measures.  It advises doctors to work on reducing risk factors such as smoking, diabetes, hypertension, high cholesterol, and obesity, and encourage patients to get more exercise.

So what if your doctor orders such a test? What then?

“When the doc says to get a test, you should ask why,” said Dr. Roger Chou, who authored the report. “As a patient, you should ask what they are basing their decision on. We don’t want to do additional tests just for the sake of testing.”

But cardiac monitoring is still indicated if you have symptoms. Or if you’re about to run your first marathon or climb your first mountain.


“Too much cardiac testing” Nicholas Bakalar, March 16, 2015, The New York Times,