Overdiagnosis of Coronary Artery Disease Detected by Coronary Computed Tomography Angiography

Schmidt, Torrey; Maag, Ronald; Foy, Andrew

doi:10.1001/jamainternmed.2016.6660

Cited by 8 publications

(8 citation statements)

References 5 publications

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“…Due to advances in science and technology, increasingly precise, minimally invasive and even non-invasive examination methods are used in clinical practice. However, what follows is overuse of certain examinations and treatments, which on the one hand causes a significant increase in economic costs, and on the other hand wastes time costs (16)(17)(18). In most countries in the world, medical resources are still scarce resources, and medical costs remain a heavy burden (19)(20)(21).…”

Section: Discussionmentioning

confidence: 99%

The impact of transthoracic echocardiography on the short-term prognosis of elderly patients in the intensive care unit: a retrospective analysis based on the MIMIC-III database

Shi

Zhu

et al. 2021

Ann Palliat Med

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Background: Elderly patients in the intensive care unit (ICU) often suffer from cardiac function impairment. Real-time monitoring of cardiac function and structural changes has important clinical significance. Transthoracic echocardiography (TTE) is a convenient, intuitive, and non-invasive real-time examination of the heart, and it has been widely used for intensive care patients. This study aims to analyze the impact of TTE on the prognosis of elderly patients in ICU.Methods: Data from elderly patients in the ICU was obtained from the MIMIC-III 1.4 database, and they were divided into a TTE examination group and a non-TTE examination group. The baseline data of the two groups were compared, and multiple regression analysis, propensity score (PS), compatibility analysis, and other methods were used to analyze the influence of TTE on the prognosis of elderly patients in ICU.Results: A total of 8,952 elderly cases were included, comprising 3,280 cases (36.6%) in the TTE group and 5,672 cases (63.4%) in the non-TTE group. The SAPS score (20.34±5.34 vs. 18.74±5.2, t=13.889, P<0.001) and SOFA score (5.10±3.38 vs. 3.82±2.81, t=19.250, P<0.001) of patients in the TTE group were higher than those of non-TTE group. The rate of patients in the TTE group receiving mechanical ventilation (52.10% vs. 34.80%) and vasoactive drugs (29.30% vs. 15.00%) was significantly higher than that in the non-TTE group. In the PS score compatibility cohort, the 28-day mortality rate of patients in the TTE group was 23.4%, and the 28-day mortality rate of patients in the non-TTE group was 28.7%.The adjusted odd ratio (OR) value was 0.76 (95% CI: 0.65-0.87, P<0.001). Analysis of secondary endpoints showed that patients in the TTE group did not use mechanical ventilation and hypertension drugs for a longer period of time than those in the non-TTE group, and the TTE group patients had significantly more fluid input in the first three days after admission to the ICU than in the non-TTE group.Conclusions: TTE examination can reduce the 28-day mortality risk of elderly critically ill patients.

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Section: Discussionmentioning

confidence: 99%

The impact of transthoracic echocardiography on the short-term prognosis of elderly patients in the intensive care unit: a retrospective analysis based on the MIMIC-III database

Shi

Zhu

et al. 2021

Ann Palliat Med

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“…Only 1 case mentioned social consequences. Table 2 provides examples of negative consequences in each domain from cases in our sample …”

Section: Resultsmentioning

confidence: 99%

“…Table 2 provides examples of negative consequences in each domain from cases in our sample. [33][34][35][36][37][38] Physical harms were depicted with greater detail than other consequences and often dominated case reports. Physical problems were typically described at length in precise clinical language, such as "[The patient] presented with acute-onset confusion, wordfinding difficulty, and short-term memory defects," 7(p1271) and "He pulled out his urinary catheter, causing severe trauma evidenced by profuse gross hematuria."…”

Section: Map Verification and Characteristics Of Case Descriptionsmentioning

confidence: 99%

Development of a Conceptual Map of Negative Consequences for Patients of Overuse of Medical Tests and Treatments

et al. 2018

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“…There is growing evidence demonstrating the presence of overdiagnosis, often arising through testing healthy people, across different areas of medicine. Examples include screening for cancer (eg, breast, prostate, thyroid), cardiovascular disease and dementia 7 8 12–16. Inappropriate screening in this context is likely to lead to higher healthcare spending and worse outcomes (eg, psychological effects and unnecessary and harmful treatments) 17–21…”

Section: Introductionmentioning

confidence: 99%

Media Coverage of the Benefits and Harms of Testing the Healthy: a protocol for a descriptive study

et al. 2019

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IntroductionMuch testing in medicine is aimed at healthy people to facilitate the early detection of health conditions. However, there is growing evidence that early detection is a double-edged sword that may cause harm in the form of overdiagnosis. The media can be seen as a major generator of consumer demand for health services. Previous research shows that media coverage tends to overstate the benefits and downplay the harms of medical interventions for the sick, and often fails to cover relevant conflicts of interest of those promoting those interventions. However, little is known about how the benefits and harms of testing the healthy are covered by media. This study will examine the media coverage of the benefits and harms of testing the healthy, and coverage of potential conflicts of interest of those promoting the testing.Methods and analysisWe will examine five tests: 3D mammography for the early detection of breast cancer; blood liquid biopsy for the early detection of cancer; blood biomarker tests for the early detection of dementia; artificial intelligence technology for the early detection of dementia; and the Apple Watch Series 4 electrocardiogram sensor for the early detection of atrial fibrillation. We will identify media coverage using Google News and the LexisNexis and ProQuest electronic databases. Sets of two independent reviewers will conduct story screening and coding. We will include English language media stories referring to any of the five tests from January 2016 to May 2019. We will include media stories if they refer to any benefits or harms of the test for our conditions of interest. Data will be analysed using categorical data analysis and multinomial logistic regression.Ethics and disseminationNo ethical approval is required for this study. Results will be presented at relevant scientific conferences and in peer-reviewed literature.

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Overdiagnosis of Coronary Artery Disease Detected by Coronary Computed Tomography Angiography

Cited by 8 publications

References 5 publications

The impact of transthoracic echocardiography on the short-term prognosis of elderly patients in the intensive care unit: a retrospective analysis based on the MIMIC-III database

The impact of transthoracic echocardiography on the short-term prognosis of elderly patients in the intensive care unit: a retrospective analysis based on the MIMIC-III database

Development of a Conceptual Map of Negative Consequences for Patients of Overuse of Medical Tests and Treatments

Media Coverage of the Benefits and Harms of Testing the Healthy: a protocol for a descriptive study

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