Stress Electrocardiography vs Radionuclide Myocardial Perfusion Imaging among Patients Admitted for Chest Pain: Comparison of Teaching and Nonteaching Hospital Services

OBJECTIVES: The American Board of Internal Medicine Foundation's Choosing Wisely initiative has identified the routine use of stress cardiac imaging among lower-risk patients as an expensive test that should be questioned by both physicians and patients. The objectives of this study were to determine how often patients hospitalized for chest pain are assessed with stress electrocardiography (stress ECG) compared with radionuclide myocardial perfusion imaging (rMPI) and to evaluate whether the cardiac testing guidelines of the American Heart Association and the Choosing Wisely campaign are being followed. We also sought to determine whether there were differences in practice patterns between a teaching and a nonteaching hospital service. METHODS: We conducted a retrospective chart review of 842 consecutive patients admitted with the primary diagnosis of chest pain to a 900-bed university-affiliated teaching hospital in Dayton, Ohio. After exclusions, we analyzed records from 111 teaching service and 94 nonteaching service patients. We assessed whether patients were evaluated with stress ECG or rMPI and compared the teaching service with the nonteaching service. Both groups may have overused rMPI, choosing it over the less costly alternative of stress ECG testing 71% of the time. CONCLUSIONS: Adherence to the Choosing Wisely recommendations for the appropriate use of stress ECG is suboptimal among both teaching and nonteaching physicians. Choosing stress ECG, when appropriate, could translate into substantial cost savings and reduce potentially harmful radiation exposure.