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Medical Decision Making
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The Value of Diagnostic Information to Patients with Chest Pain Suggestive of Coronary Artery Disease

Alvin I. Mushlin, MD, ScM

Departments of Public Health and Medicine, Weill Medical College of Cornell University, New York, NY, aim2001{at}med.cornell.edu

Lisa M. Kern, MD, MPH

Departments of Public Health and Medicine, Weill Medical College of Cornell University, New York, NY

Mary Paris, MPH

Departments of Community and Preventive Medicine and Medicine, University of Rochester, Rochester, NY

David R. Lambert, MD

Departments of Community and Preventive Medicine and Medicine, University of Rochester, Rochester, NY

Geoffrey Williams, MD, PhD

Departments of Community and Preventive Medicine and Medicine, University of Rochester, Rochester, NY

Background. The results of diagnostic tests often have a profound impact on the way patients view their health. Decision analyses and clinical guidelines do not routinely consider this, in part because methods are not well developed for measuring the value of testing to patients. Objectives. To measure the value of stress testing to patients with chest pain suggestive of coronary artery disease (CAD) and to improve methods for measuring the value of diagnostic information. Methods. The authors conducted a prospective cohort study of patients with chest pain who were referred from 44 primary care practices for treadmill testing (N = 320). Current health status, perceived life expectancy, anxiety, uncertainty, and preferences for current health states were measured before and 1 week after testing and receipt of the results. Patients also reported the diagnosis given by their physicians after testing. The authors used paired t tests to assess changes before and after testing. Results. Perceived life expectancy lengthened, anxiety decreased, and uncertainty decreased 1 week after exercise testing, compared to before (P < 0.01). For many patients, sytoms were less bothersome after testing than before. There were few changes in perceptions of current health status, as measured by the SF-36. The authors found evidence of reassurance among patients who reported that CAD had been excluded and no evidence of psychological harm among patients who reported a new CAD diagnosis. Conclusions. Patients experienced measurable psychological benefits from noninvasive diagnostic testing for CAD. Similar measurements should be standard components of diagnostic test evaluation.

Key Words: chest pain • coronary artery disease • diagnostic tests • appropriateness • value to patients

Medical Decision Making, Vol. 25, No. 2, 149-157 (2005)
DOI: 10.1177/0272989X05275157
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