Validity of vascular testing questioned

Validity of vascular testing questioned

by Kathleen Schuckel

Both recently retired, Indianapolis neighbors Eunice Shelton and Tom Moore tackled all sorts of yard projects together - even digging out tree roots until they were sweaty and out of breath. Then, one day a few years ago, Shelton received a flyer about health screenings in the mail and suggested she and Moore get tested. They went to a nearby Elks Lodge, where Life Line Screening had set up temporary operations, as it's done in hundreds of communities nationwide. For about $140 each, Moore and Shelton underwent some quick ultrasound and blood pressure tests to determine if their arteries were blocked. While Shelton's results were normal, Moore's showed critical problems, and a follow-up doctor visit confirmed his arteries were 90 percent clogged.

While Moore prepped for emergency bypass surgery, he was told to take it easy as any strenuous activity could provoke a stroke or heart attack. "We were just relieved to find out the way we did," Shelton says. "He could've had a heart attack while working in the yard."

Moore and Shelton are among the more than 6 million people tested by Life Line Screening since 1993. Of those, about 9 percent have abnormal test results. About 1 to 2 percent have disease serious enough to warrant immediate attention, says Joelle Reizes, Life Line communications director.

The Cleveland-based company tests people in the continental United States and Britain at 20,000 screening events each year, offering ultrasound tests, EKGs, blood pressure and blood tests. Going through the screenings carries no medical risks.

Other, smaller companies such as Texas-based HealthYes! and Ultrascreen in Todd, N.C., perform similar work. Many hospitals and doctors' offices do also. No matter who does the testing, the cost is almost never covered by insurance.

Not everyone is sold on these ultrasounds, which test artery blockage in the neck, stomach and legs. "What we really need is more education about nutrition and exercise," says Dr. John F. Tugaoen, an interventional cardiology specialist with MidOhio Cardiology and Vascular Consultants in Columbus, Ohio. "People need to focus on taking care of themselves instead of worrying about screening tests." While he sees no harm in getting tested, he urges patients to show the results to their physicians. "We can tell whether the quality of the test was good," he says.

Joni Rusk worries many in her Eugene, Ore., community are looking for some magic health cure. She watched recently as elderly people hobbled into a testing center. "They were more out of shape than I was and didn't know any better," Rusk says. "It reminded me of the old-fashioned snake oil traveling salesman."

Reizes takes offense at that viewpoint. She notes that Life Line also sponsors free health seminars that emphasize a heart-healthy lifestyle. The for-profit company encourages patients to share tests results with their physicians. "We're not here to scare, but to inform," she says. "We feel strongly that we're here to help people before a stroke or heart attack occurs."

Doctors often prefer their own staffs conduct the screenings. "There's a lot of momentum in medicine to provide more detailed and sophisticated testing," says Dr. Irwin J. Weinstein with the Orlando Heart Center. "But it's easy to lose sight of the most important part of health care - doctor-patient interaction."

Sacramento, Calif., resident Marsha Scribner, 64, gets screened by Life Line every five years. "I have these tests done so I can be proactively ahead of the game," she says. A nurse and avid traveler, Scribner notes her exotic vacation locales don't have quality medical care. Dr. Kelly Spratt, University of Pennsylvania cardiologist, says Scribner's approach makes sense. "It's a small fee if it gets a patient into the thought process of caring for his or her heart," she says.

Primary care physicians should be identifying their patients' risks of cardiovascular disease during annual physicals, says Dr. Jonathan Fialkow, a founding member of the Cardiovascular Center of South Florida. These include whether the patient smokes, has diabetes, exercises and has a family history of heart disease. Blood pressure readings and cholesterol screenings are much better predictors for cardiovascular disease than ultrasound tests, cardiologists agree.

In Moore's case, the ultrasound raised a critical red flag. His bypass surgery was a success, and he's now a hearty 78-year-old. Shelton is healthy at 72. In fact, both of their hearts might beat more rapidly these days - the next-door neighbors became sweethearts and are married now, living near Naples, Fla. "I truly believe that screening saved his life," she says.


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Roland Weisser

Subject:

what is the cost benefit ratio of these tests? What is the rate of false positives and the additional costs incurred by them? If this is considered a public health screen it would make better sense to screen a specific population. what are the statistics?

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