When it’s OK to defer a cardio stress test

Stress testing may not always be necessary for those with non-urgent chest pain, say cardiologists.

Their two-year follow-up study involving more than 10,000 people with stable chest pain shows a quarter of non-invasive cardiac tests can be safely deferred.

Published in JAMA Cardiology, the study randomised participants to have either an exercise stress test (often with an imaging study of heart blood flow or function) or a CT scan of the coronary arteries.

While the research found both tests to be equally accurate in detecting heart trouble, it determined that approximately 25% of patients had completely normal results.

So the researchers developed a web-based, risk prediction tool to identify these patients using pretest characteristics alone, including risk factor profile, symptom characteristics and lipid values.

“These variables can be used to inform a user-friendly point-of-care decision support tool quantifying the likelihood of having a normal test result and no clinical events,” they write.

“If a high likelihood of a normal test result and low clinical event rate is identified, clinicians could consider, including through shared decision making, a strategy of deferred testing for such patients because the benefit and value of testing are likely to be low.”