Heart disease and rise in testing don't match up

NEW YORK (Reuters Health) - In the U.S., increases in the rate of heart disease do not explain why testing and treatment for cardiac disease has increased so dramatically, a new study in the American Heart Association's journal Circulation suggests.

"We wanted to describe the increased use of cardiac testing and treatment, and to explore a couple of potential explanations for why 'more might be better,' but we found that those explanations weren't true," Dr. F. Lee Lucas told Reuters Health.

Lucas and colleagues at the Center for Outcomes Research and Evaluation, in Portland, Maine, performed a study of Medicare patients to look at the use of various heart disease tests, as well as at hospitalizations for heart attack.

The use of stress tests, a type of imaging test that evaluates blood flow to the heart muscle, increased dramatically from 1993 to 2001. In addition, rates of angioplasty, a common treatment for blocked coronary arteries, rose during the study period.

By contrast, heart attacks rates held fairly steady, the report indicates.

"One of our hypotheses was that that the rates of the procedures went up because the rate of heart disease went up, but the (heart attack) rate, which is an easy way to measure the most serious heart disease, didn't change," the researcher commented.

Regarding race and gender, Lucas and her colleagues found that, although all of the subgroups received more procedures over time, the gap between them didn't change. The team had speculated that rates were going up because underserved populations, women and blacks, were getting more treatment, but that turned out not to be true. "White men still get more than women and black people," Lucas said.

She noted that Canadian researchers who published a similar article in the same issue of Circulation are saying that, in Canada, the rates have gotten too high, and that they can't afford those treatments.

"Our rates are much, much higher than they are in Canada, and they keep going up, and that costs somebody something. What are we buying?" Lucas wondered. "We are not sure that we are buying anything good."

SOURCE: Circulation, January 2006.