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Heart disease screenings are urged - 2006/07/16 19:34
July 15, 2006
All men ages 45-75 and women 55-75 should be tested, says physicians task force
Men ages 45 to 75 and women 55 to 75 should undergo non-invasive screenings for heart disease, even if they have no symptoms of the nation's No. 1 cause of death, a physicians task force is recommending.
The guidelines, published in today's American Journal of Cardiology, an independent scientific journal, urge doctors to use imaging tests such as a CT scan or ultrasound to determine whether plaque has built up in the arteries.
Most insurance companies do not cover cardiovascular screening tests, which can cost from $100 to $400. Indianapolis-based WellPoint Inc., the nation's largest health insurer, considers the tests "investigational," which means it doesn't reimburse the cost, said Tony Felts, a spokesman for Anthem Blue Cross and Blue Shield, a subsidiary of WellPoint.
The Screening for Heart Attack Prevention and Eradication task force, or SHAPE, hopes its article will start a dialogue to change that, said Dr. Prediman K. Shah, leader of the team of physicians.
Traditional screening methods look at a person's family history, blood pressure, age, cholesterol and history of smoking and diabetes. Cardiologists need to change their screening because the traditional methods often miss identifying many at risk for heart disease, the task force doctors say.
"This is a complete change in the paradigm," said Shah, a cardiologist at Cedars-Sinai Medical Center in Los Angeles.
"It's no different than screening for breast cancer," he said. "You don't look for risk factors; you look for the disease."
About half the 1.5 million Americans who have heart attacks each year do not know they have cardiovascular disease before the attack. The imaging tests could prevent more than 90,000 deaths each year and save about $21.5 billion annually, the task force says.
Dr. Elisabeth von der Lohe, a professor of cardiology at the Indiana University School of Medicine who is not involved with the task force, agrees with the need for more tests earlier.
"I think we did not do a good job in the past," she said. "We have to do something, but I don't know what the best way is. I really don't know."
Cardiologists disagree on which tests are more effective in detecting signs of heart disease.
Dr. Douglas Zipes, distinguished professor of medicine at IU's School of Medicine, said other imaging tests may do a better job of predicting which patients eventually will suffer a heart attack.
"The concept is interesting, but I think it needs to be tested in a prospective controlled trial," said Zipes, who is on the editorial board of the American Journal of Cardiology but not involved with the task force. "Once the results of such a trial are known, then we could consider widespread application."
Dr. Elaine Moen, a cardiologist with the Care Group at the Heart Center of Indiana, said how the tests are paid for most likely will determine whether the task force's recommendation flies.
"The insurance companies need to look hard at this," she said. "Do they need to pay for a huge outlay when someone has a heart attack, or should they get more into the realm of prevention?"
Dr. Robert Bonow, a Northwestern University professor of medicine and past president of the American Heart Association, said traditional methods work with assessing those at risk of heart disease, as long as people without symptoms are checked for it.
If nothing else, he said, the task force guidelines may spur physicians to increase screening of patients.
"Maybe this will raise awareness that we need to do better in our prevention strategies," he said.
The American Heart Association and the American College of Cardiology are expected to update their recommendations for screening in the coming months, Bonow said.
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