News: More referrals for cardiac tests not linked to better outcomes, study shows

According to a recent study published in the American Heart Association Journal, an increase in referrals for noninvasive cardiac testing (NICT) was not associated with improved outcomes for lower-risk patients with acute myocardial injury already ruled out for their chest pain. The study results also showed no significant decrease in the adjusted hazard ratio of major adverse cardiac events (MACE) for both the intermediate referral group and high referral group within two years, MedPage Today reported.

This study reviewed data from 144,577 patient encounters at 21 emergency departments within a healthcare system in northern California from 2013 to 2019, where patients presented with chest pain and an accompanying serum troponin level measurement. Patients had a median HEART (history, ECG changes, age, risk factors, and troponin) score of 4, 48.2% were low risk, 49.2% were moderate risk, and 2.7% were high risk. Researchers found that results were similar across HEART risk scores, as well as when they considered all-cause mortality and coronary revascularization as clinical outcomes.

The researchers concluded that their findings support current guideline recommendation against urgent use of NICT in low-risk emergency department patients with chest pain, given the lack of evidence of improved clinical outcomes, which instead should be reserved for patients at high coronary risk or those with elevated serum cardiac troponin levels.

“[T]o answer the fundamental question of whether 'To test or not to test?', the unfortunate answer is that we still do not know,” the authors wrote. “The only reliable method to address this question definitively is through a well-executed randomized controlled trial. Until such research is available, we must rely on conflicting data from observational studies.”

Editor’s note: To read MedPage Today’s coverage of this story, click here. To read the American Heart Association Journal study, click here.