"[The 36 percent cut] was an unsustainable blow," he says. "It's a deal breaker for the business."

Soffer points out that stress testing is the most effective tool for diagnosing cardiovascular disease - the number-one killer in the country.


"This modality is the only way to look into the heart effectively, without cracking someone open," Soffer says.

A heavier population means more business

According to the World Health Organization, more than 16 million people die of CVD. Stress testing is considered the top diagnosis tool for CVD and respiratory conditions, which is "expected to drive revenue growth and investor interests in the global [cardiopulmonary stress testing systems] market," states GlobalData, a market research company, in its Global Cardiopulmonary Stress Testing Systems Market Analysis and Forecasts to 2015 report.

In fact, the United States remains the largest revenue generator within the global CPST systems market; it's expected to grow at a compound annual growth rate of 9.5 percent between 2008 and 2015, according to the report. That's higher than the global average of 8.7 percent.

Manufacturers and refurbishing companies aren't surprised by this information. Both Avina and Buyukoglu recognize that heart disease related to obesity will cause an increase in the need for stress testing.

"One [trend] is linked to the rich countries' obesity and diabetes, [which is] still growing," says Buyukoglu. "They represent all of the potential coronary diseases in the near future and will need stress testing."

Over the last five years, the number of indications for the prescription of a CPST test has almost tripled, according to the GlobalData report. The test is being used as a diagnostic tool for more than 10 clinical symptoms, whereas before, used mainly for assessment of cardiac or pulmonary function prior to surgery.

Stress testing makes headlines

In March, Delaware resident Michael Fields was denied a cardiac stress test three times. He ultimately underwent life-saving quadruple bypass surgery to clear an arterial blockage that would have been found in a stress test and could have been treated in a less invasive way.

Stress testing has been the subject of insurance denials in Delaware by four top companies, including Aetna, Blue Cross Blue Shield of Delaware, Coventry Health Care and Cigna. The companies, which contracted MedSolutions to review preauthorization claims, are being investigated by Delaware insurance Commissioner, Karen Weldin Stewart.

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