What are the indications for cardiac testing?

Updated: Nov 20, 2018
  • Author: Richard S Krause, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Aside from new testing modalities, there is considerable research under way to better optimize the selection of noninvasive tests for patients presenting with chest pain. In particular, there is substantial discussion regarding an acceptable risk level and defining a population of patients who are at low enough risk that they can be safely discharged without further cardiac testing. It is well known that when patients who present with chest pain have unchanged ECG’s and negative biomarkers, they are already at low risk for adverse cardiac outcomes even without the use of noninvasive testing.

One suggested approach is to use a validated risk score such as the HEART score to define a population at low short-term risk for major cardiac events. [41] If the score is low enough, then a shared decision-making tool may be used with a patient. [42] If a patient can understand and accept that their risk of adverse cardiac event is very low but more than zero, they may be discharged without further cardiac testing. Ultrasensitive troponin testing may be able to define an even lower risk population. Using these newer approaches, clinicians may be able to become far more selective in whom to choose to undergo noninvasive cardiac testing. This has the potential to both lower costs and adverse outcomes.

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