February 28th, 2011
What is the Role of CV Screening Tests in Medicine and Legislation?
Three papers in Archives of Internal Medicine scrutinize the role of cardiovascular screening tests not only in medicine but in legislation. In the first article, Nicholas Wald and Joan Morris introduce a new interactive tool that determines the detection and false-positive rates of screening tests. The authors illustrate the value of the tool with the examples of CRP, coronary calcification, glycated hemoglobin, and the QRISK score.
In an accompanying editorial, Thomas Wang writes that the tool “illustrates just how poorly most risk markers perform as screening tests.” He notes the inherent limitation of most screening tests, since “use of these tests requires that the screening threshold be set so low that most who screen positive for events will never have one, or so high that most cases of disease will be missed.”
In a separate commentary, Amit Khera discusses the “broad implications” of a 2009 Texas law mandating insurance coverage for imaging tests used for CV screening. Khera writes that the bill was passed based on input from the controversial Society for Heart Attack Prevention and Education (SHAPE), with no input or support from the AHA or ACC, and with no basis in evidence derived from randomized and controlled clinical trials. “The added costs and potential risks of these imaging tests necessitate a higher level of evidence before considering a broad legislative mandate,” Khera writes.
In an editor’s note, Rita Redberg writes that “at a time when states are facing crises in health insurance spending and cutting lifesaving treatments, and when Texas leads the nation in the percentage of residents without health insurance, it is remarkable that Texas has chosen this path.”