Despite offering no "net benefit", the U.S. spends as much as $101 billion annually in low-value healthcare. And due to the wide availability of cardiac screening and diagnostic tests, overuse of these exams is common and makes low-value testing a frequent challenge in cardiovascular care.

For instance, one in five echocardiograms and up to half of all stress tests performed in the U.S. may be rarely appropriate, according to established guidelines on their use, as are up to 15% of percutaneous coronary interventions.

This can result in added health risks such as exposure to radiation and hospital-acquired infections, according to the American Heart Association. In an effort to reduce the chance of these risks, the association has published a statement that lists possible solutions for decreasing low-value cardiovascular care.

“Our desire to be vigilant about treating and preventing cardiovascular disease may sometimes lead to use of tests and procedures where the benefits to patients may be uncertain. This may impose burdens on patients in the form of increased risk of physical harm from the low-value procedure or potential complications, as well as follow-up care and out-of-pocket financial costs,” said Dr. Vinay Kini, chair of the statement writing group and assistant professor of medicine at Weill Cornell Medical College in New York, in a statement.

Close to 50% of U.S. patients will receive at least one low-value test or procedure annually. The National Academy of Medicine says the country spends approximately $76-$101 billion on care considered to be unnecessary or wasteful. Additionally, greater production of consumer devices helps drive up these costs. For example, devices that monitor heart rate and physical activity also assess heart rhythms. Yet, more than one-third of these recordings may be misinterpreted by clinicians and patients.

By assessing medical and economic documentation of low-value healthcare since 2000, the authors came up with the following options for reducing it in cardiovascular care.

• For patients: Patient education and shared decision-making, especially on the misconceptions about the intended purpose of a test or treatment.


• For professionals: A "layered" approach, such as through education, audit and feedback; and behavioral science tools to shift behaviors and practices, i.e. using generic rather than brand-name medication use.


• For payers and policy leaders: Implementing national insurance coverage determinations; prior authorization; alternative payment models that reward lower costs and higher quality healthcare; value-based insurance designs that financially penalize low-value care; and medical liability reform to reduce defensive medical practices.

Reducing low-value healthcare requires a multidisciplinary approach of research, implementation, evaluations and adjustment. Ensuring equitable access to care is also necessary, and policies and interventions must be designed to address the needs of people in historically under-resourced communities and from diverse and ethnic groups. The authors say rigorous studies are needed to validate these interventions and identify potential unintended consequences.

Additionally, research is required on new ways that patients and healthcare professionals can discuss the value of tests and treatment and assess the effectiveness of payment models designed to improve healthcare value, according to Kini. “Prior authorization imposes a large burden on healthcare professionals to obtain insurance approval for tests and treatments. Prior authorization and some value-based payment models may unintentionally worsen existing racial and ethnic healthcare disparities. A one-size-fits-all approach to reducing low-value care is unlikely to succeed; rather, acting through multiple perspectives and frequently measuring impacts and potential unintended consequences is critical.”