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Doctors may be sending patients too quickly for elective angiography to detect heart disease, exposing them to radiation and driving up U.S. healthcare costs, a study suggests.

An analysis of records of about 400,000 patients concluded that 37.6 percent who underwent angiography to find obstructed heart arteries showed evidence of significant blockage, according to research published in the New England Journal of Medicine. A total of 39.2 percent displayed none. Most of the patients had been sent for angiograms after initial screening suggested blood vessels might be blocked.

The amount of disease discovered was lower than the researchers expected and indicates that doctors need better diagnostic tools before deciding to proceed with catheterization for angiograms, said Manesh Patel, a cardiologist at Duke University in Durham, North Carolina, and one of the authors of the study.

The study authors said use of medical imaging tests, including angiograms, has pushed up medical costs. They cited a federal study of Medicare that showed spending on imaging services doubled to $14 billion in 2006 from six years earlier.

Americans are exposed to twice as much radiation compared with 30 years ago because of a six-fold increase in the use of medical imaging, said David Brenner, director of the Center for Radiological Research at Columbia University in New York, in an editorial in the Journal.

Brenner recommended a switch from stress tests to cardiac computed tomography, which he said has been shown in early clinical testing to be more efficient at identifying patients without blockages. CT may be more costly than stress testing and also exposes patients to radiation. Increased use of CT would most likely reduce catheterizations and cut costs, he said.

Thirty percent of the entire group had showed no symptoms before angiography, so the decision to proceed with catheterization was driven by doctors’ assessment of risk and testing for circulatory problems, according to the authors.

Given the amount of coronary disease uncovered by the angiograms, a higher threshold should be used for deciding which asymptomatic patients get catheterized, the authors wrote. The “primary benefit of invasive treatment” is relief from pain and other symptoms, the researchers said.

Source : The New England Journal of Medicine

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