Dr. Joseph Ladapo Awarded for Study on Overuse of Heart Disease Tests

Physician honored with junior investigator award from American College of Physicians and Annals of Internal Medicine

Wednesday, May 13 2015

Advances in diagnostic technology have improved doctors’ ability to identify and treat coronary heart disease, but some of these tests are at the heart of a debate about rising healthcare costs and overexposure to radiation, which poses a cancer risk. 

Providing evidence-based research to inform this debate drives the work of Joseph Ladapo, MD, PhD, an assistant professor in the Department of Population Health at NYULMC. Dr. Ladapo was recently honored for his work by the Annals of Internal Medicine and the American College of Physicians with a Junior Investigator Recognition Award, which he received at ACP’s annual scientific meeting in Boston in early May.

Joseph Ladapo, MD, PhD
Joseph Ladapo, MD, PhD

The award recognizes the most outstanding article by a first author within three years following completion of training in internal medicine or one of its subspecialties. (Another category recognizes the most outstanding article by a first author in an internal medicine residency program or a general or internal medicine subspecialty fellowship program.) “Winners are selected based on the article’s novelty, methodological rigor, clarity of presentation, and potential to influence practice, policy, or future research,” according the ACP.

“It was really exciting to win the award,” said Dr. Ladapo “I’m deeply grateful to the ACP for their consideration and to my collaborators for their exceptional contributions.”

A Growing Cause for Concern

In the winning paper, published in Annals in October 2014, Dr. Ladapo and co-authors Saul Blecker, MD, MHS, assistant professor of population health and medicine at NYULMC, and Pamela S. Douglas, MD, a professor of medicine at Duke University, reported a steady increase in the use of cardiac stress testing with imaging on patients over the course of 18 years. Their research found that in 30 percent of these cases, the tests “were ordered for or performed in patients in whom they were rarely appropriate.” The results are especially concerning because these tests drive up the cost of healthcare to the tune of hundreds of millions of dollars, and put patients at increased risk of cancer from radiation exposure. The increase could not be fully explained by population demographics, risk factors, or provider characteristics.

The study also found that physician decision-making about cardiac stress tests did not contribute to racial and ethnic disparities in cardiovascular disease. The paper is called “Physician Decision Making and Trends in the Use of Cardiac Stress Testing in the United States: An Analysis of Repeated Cross-sectional Data.”

“Millions of patients present to physicians’ offices each year with symptoms suggestive of coronary heart disease, and there is still much we don’t know about how to improve their medical management—including how to help them make healthier lifestyle choices,” said Dr. Ladapo. “We are working to better understand how cardiac stress testing might be a ‘teachable moment’ for patients with cardiovascular risk factors, while also trying to reduce patients’ exposure to unnecessary tests and invasive procedures.”

Too Much of a Good Thing

There are several different types of cardiac stress tests that doctors use to test for cardiovascular disease. In most imaging tests, a small amount of radioactive substance is injected into the patient. Through a camera, doctors can view rays emitted from the substance to see if there are abnormalities in blood flow to the heart muscle.

Stress tests are done to evaluate chest pain, measure heart function after a heart attack, or establish a baseline for patients with multiple risk factors for cardiovascular disease. The most common inappropriate use of a stress test with imaging was for patients with hypertension.

Several professional organizations are involved with efforts to reduce unnecessary testing and radiation exposure from tests, including the American College of Cardiology, American Society of Nuclear Cardiology, and American College of Radiology.