February is American Heart Month, and this year there's new attention on various heart screening tests. A major new survey from Consumer Reports finds that a lot of patients are being screened with little benefit from the tests.
The question in the clinic then is how to screen more efficiently while still ensuring that patients get the tests they need. Dr. Jon Hallberg spoke with MPR's Tom Crann about heart screening and which tests are worthwhile.
Tom Crann:What kinds of tests are we talking about?
Dr. Jon Hallberg:There are probably nine tests that fall into this umbrella of heart-screening, and they range everywhere from very simple things like blood pressure checking and cholesterol levels, which everyone is familiar with, to slightly more advanced and newer things like CRP levels, markers and protein levels.
Crann:Which ones of those are the surefire, most essential tests?
Hallberg:I think all of the major bodies that make these recommendations would say that knowing one's blood pressure and knowing your cholesterol and lipid levels are at the top. There's just very little controversy about that.
Crann:That would be recommended for almost all patients.
Hallberg: Absolutely. In fact, we're paying attention to blood pressure in young patients, adolescents and in some case even checking their cholesterol.
Crann: Which ones tend to be unnecessary?
Hallberg: I think that the EKG, the electrocardiogram, is the one that many people are used to getting. Long ago, we realized that there is very little utility in that. We just don't really learn a lot by that, so we really have given up that routine aspect.
Crann: As a patient, what's the best way to go about knowing which ones you need at any given time or given age, and which ones you can probably forgo?
Hallberg: This really gets down to patients knowing if they are at low, intermediate or high risk for heart disease. To be honest with you, I had to look this up myself. As a physician, I sort of intuitively know that. But the fact is that a lot of people who are low risk are getting way too much done, and people who are high risk are getting things done that, frankly, they don't need to. It's really that intermediate risk group that we need to focus on.
Crann: How do you go about finding out what group you're in?
Hallberg: Part of it is based on risk factors. People in that intermediate group might smoke or they might have high cholesterol, and all of this can be stratified by doing a self-test. If you go online it's so easy to find risk calculators, and it gives you a sense, in 10 years, of what your risk is in having a heart attack.
Crann: Also, there's a similar test just you putting your age and your gender, and it tells you which tests are more likely helpful and which ones you can probably pass up.
Hallberg: This is from Consumer Reports Health website, and I did it myself. I have to say it's one of the cleanest, most simple things I've come across a long time. I did recommend this to some of my patients. It starts at the top and in my case, blood pressure and cholesterol are very likely to be of benefit and not have much harm. At the low end of the spectrum was checking for clogged carotid arteries in my neck, which is very unlikely to be of any help.
Crann: What's the concern or harm in getting an extra test that you might not need 100 percent?
Hallberg: Most of the tests we're talking about don't cause harm to anybody. It's possible if someone had a stress test and then they went on a treadmill, and there was a problem. But they likely had significant disease to begin with.
I think that many of these, especially if not done in a good way, are sort of opening Pandora's Box. You're getting a sense from a screening of clogged arteries that maybe there's some blockage. Well, now you've got to go to your primary care physician, get the proper tests done and then be told that really there is no problem. So, I see that all the time. People sort of want to get things done -- for all the good reasons -- and wanting to screen disease before it becomes an issue, but they're in fact getting the wrong tests done.
Crann: This survey we are talking about comes from Consumer Reports, like last week's topic on doctor and patient expectations. I'm wondering what it says about consumer-driven healthcare. Hallberg: I think that they're onto something that groups like the U.S. Preventative Health Services Task Force have sort of failed a little bit. It has made it very easy, very consumer friendly to get a sense of where your money is best spent.
I think that these days, when people have very tight budgets, to go to a website like this, find this information, and know where you should be spending your resources, time, energy and money is not a bad idea at all.
Crann: You're confident from Consumer Reports that this data is pretty solid?
Hallberg: It's not that Consumer Reports is making these decisions. They're basing it on really sound, huge volumes of information and studies. But they're taking information that is already there and making it available, understandable -- putting it in a way that's visually easy to understand and navigate.
Crann: As a primary care physician, what is the takeaway for you in the clinic?
Hallberg: Many of my colleagues and I have not been put in the position of encouraging unnecessary tests for the most part. We've known this now for a decade or more. I think when it helps us is when patients come in and ask for these unnecessary tests we have a little ammunition now. We can say that more and more groups, including the American Heart Association, are saying that many of these tests are unnecessary. We can say, "You're at low-risk. You simply don't need this." I think we can reassure patients and test the people who need to be tested.
(Interview transcribed by MPR reporter intern Anissa Stocks)