BackgroundThe World Wide Web and social media provide the public with access to medical information unlike any other time in human history. However, the quality of content related to cardiac stress testing is not well understood.ObjectiveThe aim of our study was to evaluate the quality of content on the Internet relating to the use of cardiac nuclear stress testing and the Choosing Wisely campaign.MethodsWe searched the World Wide Web, Google Video (including YouTube), and Twitter for information relating to these two topics. Searches were performed using English language terms from a computer in the United States not logged into any personal user accounts. Search results were reviewed for discussion of specific topics including radiation risk, accuracy of testing, alternative testing options, and discouragement of inappropriate test use.ResultsWe evaluated a total of 348 items of content from our searches. Relevant search results for Choosing Wisely were fewer than for other search terms (45 vs 303). We did not find any content which encouraged inappropriate testing (ie, screening in low risk individuals or testing prior to low risk operations). Content related to Choosing Wisely was more likely to discourage inappropriate testing than search results for other terms (29/45, 64% vs 12/303, 4.0%, odds ratio 43.95, 95% CI 17.6-112.2, P<.001).ConclusionsThe Internet content on nuclear stress tests consistently discouraged inappropriate testing. The Choosing Wisely content was more likely to discourage inappropriate testing, less relevant content was available. Generating authoritative content on the Internet relating to judicious use of medical interventions may be an important role for the Choosing Wisely campaign.

Background: Approximately 14.8% of nuclear myocardial perfusion imaging (MPI) tests in the United States are unnecessary. Patients and doctors are increasingly using social media and the web as part of their health care decisions. Little is known about the accuracy of information about MPI available to patients on social media which may affect patient education and joint decision making. The goal of this investigation was to determine whether information for patients on social media portrays an accurate representation of the risks and appropriate usage of MPI. Methods: We searched on Google Video, Google Web, and Twitter using search terms “nuclear stress test” (NST), “myocardial perfusion imaging”, and “choosing wisely stress test” (CW). Search results that did not specifically discuss MPI, were duplicative, or not English were discarded. Each search was continued until results were no longer relevant to the search term and topic. We evaluated all results for mention of radiation risks, alternative testing, possibility of false positive/negatives, and discouragement of unnecessary use such as annual/low risk/asymptomatic screening. For the primary outcome, we compared how frequently the results from each search term discussed unnecessary MPI. Results: None of our search results yielded material that encouraged unnecessary MPI. Radiation risks, alternative test options, and false positives/negatives were inconsistently discussed across search terms and sources. (Table) Depending on the search term, discouragement of unnecessary testing varied, 1.79% for NST, 10% for MPI, 64.4% for CW. In pairwise comparisons, search results for NST were less likely to discourage unnecessary testing than MPI (odds ratio [OR] 0.179, 95% confidence interval [CI] 0.044-.68, p = 0.005) and MPI was less likely to discourage unnecessary screening than CW (OR 0.155, 95% CI 0.059-0.393, (<0.0001). Conclusion: Publicly available information on the internet and social media does not encourage unnecessary testing. Depending on the search term used, unnecessary testing may be commonly or rarely discouraged. Important topics related to nuclear MPI, such as radiation and alternative testing options are not widely discussed.