Don’t perform exercise stress test as screening of ischemic heart disease in asymptomatic patients at low cardiovascular risk
In asymptomatic patients without risk factors, the likelihood of coronary heart disease is very low. The stress test increases risk of false positives and induces further diagnostic tests to rule out the doubts raised by the test.
Don’t perform 24 hour Holter monitoring in patients with effort chest pain who can perform exercise stress test, unless arrhythmias should be investigated.
Since during Holter monitoring the amount of stress could not be calibrated, sensitivity and specificity for detecting ischemia in patients with chest pain are low. In these conditions stress test is superior.
Don’t perform exercise stress test as part of routine follow-up in asymptomatic patients after surgical or percutaneous revascularization.
Since there are no RCT showing events’ reduction with tress test procedure after revascularization, stress test should only be performed to evaluate incomplete revascularizations or changes in clinical status.
Don’t perform routine echocardiography as part of routine follow-up in patients with mild to moderate valvular heart disease or with left ventricular dysfunction, in the absence of new symptoms, signs or clinical events.
Due to the slow evolution of mild to moderate valvular disease and the clinical uselessness of reevaluating left ventricular function in clinically stable patients, an echocardiogram is not recommended unless there is a change in clinical status.The campaign DOING MORE DOES NOT MEAN DOING BETTER – CHOOSING WISELY ITALY is promoted by Italy’s Slow Medicine
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