Anticipated Rates and Costs of Guideline-Concordant Preoperative Stress Testing

Area of Science:

• Cardiology
• Health Economics
• Medical Guidelines

Background:

• Current guidelines recommend preoperative cardiac risk assessment and stress testing for elevated-risk patients with poor functional status.
• Little is known about the actual rates of preoperative stress testing and associated medical costs in the US.
• This study aimed to estimate testing rates and costs under current guidelines and compare risk prediction methods.

Purpose of the Study:

• To estimate the expected rates of preoperative stress testing if US physicians follow current guidelines.
• To calculate the resultant nationwide direct medical expenditures for preoperative stress testing.
• To investigate differences in testing rates and costs arising from two guideline-recommended risk prediction methods.

Main Methods:

• Applied two risk prediction tools (Revised Cardiac Risk Index and Myocardial Infarction or Cardiac Arrest) to a US multicenter prospective registry from 2009.
• Calculated expected rates of preoperative cardiac stress testing based on American College of Cardiology/American Heart Association guidelines.
• Determined expected nationwide direct medical expenditures and assessed agreement between the two risk prediction tools.

Main Results:

• Current guidelines imply substantial spending on preoperative stress testing, varying by risk tool and functional status assessment.
• Testing rates and spending are significantly higher for elevated-risk patients compared to low-risk patients.
• The two guideline-recommended risk assessment tools show poor agreement beyond chance at the recommended risk threshold.

Conclusions:

• Preoperative stress testing represents a considerable source of medical spending, potentially without proven benefit.
• Further research is needed on appropriate perioperative risk assessment tools, risk thresholds for patient selection, and functional status assessment reliability.