I have a question for all my esteemed cardiology colleagues out there; preferably the ones following evidence-based guidelines instead of the ones who order tests based on their student loan, tuition, house and car payment due dates.
Now that it's been shown that stenting coronary arteries only helps in the setting of acute coronary syndrome or unstable angina (ie, actual symptoms) what is the purpose of "routine" annual stress testing for patients with stable coronary disease?
Assuming that all of them are on statins with an LDL goal of 80 or less, have been convinced to stop smoking and have their blood pressures adequately and have normal LV function by echocardiogram, why do they need repeat stress testing in the absence of symptoms? For that matter, without a murmur or symptoms suggestive of valvular heart disease and a structurally normal heart documented once (you can't call yourself a cardiac patient without having an ehco) what advantage is there from repeating echocardiograms on a regular basis either?
Seems to me like the main thing outpatient cardiologists do -- other than ordering annual stress tests and echoes, along with EKGs at every visit -- is exhort patients to exercise and stop smoking. What really roasts my beef is when patients ignore the same advice from me.