Proactive Cardiovascular Testing
by Dr. Jessica Schneider
Coronary heart disease (CHD) is the leading cause of death in adults in developed countries and can often exist in patients with minimal or no symptoms. Because of its mortality rate, it’s incredibly important to catch it as early as possible in order to reverse the effects before long term damage is done.
In fact, it’s very common in CHD for symptoms to develop rapidly all at once. Unfortunately, by the time the first clinical manifestations of CHD appear, mortality rates of the disease skyrocket. Because of this unique pathology of CHD, it’s incredibly important to catch it as early as possible in order to reverse the effects before long term damage is done.
There are many ways to screen for early CHD, each with its own pros and cons. Many patients do not realize the wide breadth of testing available for CHD, and therefore have a hard time making an informed decision that’s the best for them and their current financial situation. We hope to shed some light on this subject to make conversations with your doctor about CHD concerns that much easier. Here are some of the most popular screening tests for CHD that are available.
Stress Testing
What is it?
Stress testing measures the heart’s ability to respond to external stress which allows cardiologists to observe circulation and blood flow through the heart.
Stress testing is commonly done either by having patients exercise, typically on a treadmill, or in cases where patients aren’t able to endure the strenuous exercise, the stress can also be induced by medication. There are additional variants of stress testing like nuclear stress testing and stress echocardiography (ECG) that can give additional information about how the heart is performing.
Pros
The procedure is completely non-invasive and adjustable, making it safe and accessible for many different types of patients.
For patients already diagnosed with CHD or presumed to have CHD, the information gathered from these tests can provide valuable information that can be used to treat the root issues.
Cons
There have been some concerns about the effectiveness of using stress testing on asymptomatic patients, as the results of the test for these individuals don’t seem to reliably determine CHD.Add-ons for this kind of testing, like nuclear testing or ECG testing, can be especially expensive and the data on how to use the results are not completely understood at this point.
Average cost with and without insurance
Pricing with insurance can vary widely based on coverage, plan, and deductibles. Typically, patients are left paying around $50-300 after insurance coverage for an exercise stress test.
Cash pay options also vary based on where the test is performed. For patients of Empowered Health, we are able to offer an affordable cash pay option of $200 for an exercise stress test.
Note that these prices can also vary based on the type of stress test being performed, with nuclear stress testing usually being the most expensive.
Coronary Artery Calcium (CAC) Scoring
What is it?
CAC scoring is a screening test that measures calcification occurring in the heart. The presence of calcium in the heart can be an indicator of CHD or other cardiovascular issues. CAC scoring is done via a CT scan that picks up the plaque buildup in the heart.
Pros
Unlike other types of screening tests and typical imaging, CAC scoring does not need any sort of preparation like fasting, medications, or imaging contrast.
Results of the screening test provide valuable information for treatment of both symptomatic and asymptomatic patients.
Cons
Many other CHD screening tests can be billed through insurance, but because CAC is still considered new, many insurance agencies do not cover it. Therefore, CAC scoring is usually only offered on a cash pay basis.
Average cost with and without insurance
As mentioned, this test is usually only offered on a cash pay basis. Here in the Tri-Cities, In-Land Imaging (formerly Tri-City Radiology) offers CAC scoring for $200 cash pay.
CT Coronary Angiography
What is it?
CT coronary angiography is an imaging test that that provides a detailed look that the heart and arteries. This test can help identify narrowed or blocked arteries in the heart, which is one of the leading causes of CHD.
Pros
Unlike traditional coronary angiography, this test is non-invasive.
The imaging results that are received from this test can provide important information for treatment purposes for both asymptomatic and symptomatic individuals.
Cons
The procedure does require some preparation such as fasting, the use of specific medication, and IV contrast.
For patients with known CHD and dangerous symptoms, a traditional (non-CT) angiography is recommended, which involves the use of a catheter and can be less comfortable and more invasive.
Average cost with and without insurance
This test can be run through insurance and if considered medically necessary can often be covered. That coverage of course varies by plan, deductible, and facility. In general though, the patient cost of this test with insurance usually is around $300-600.
Cash pay prices for this test vary greatly by facility. It would appear that the general cash pay price is around $500-600.
Blood Testing
What is it?
Testing the blood for various markers of CHD can be one of the first steps in screening for the disease. Common markers that are looked at include serum cholesterol levels and high-sensitivity C-reactive protein. Additionally, more advanced blood testing can be done like a lipid NMR profile, which can break down serum cholesterol into more detailed data.
Pros
These tests are completely non-invasive and only require a short blood draw to complete. Because they don’t involve complicated imaging, they also tend to be less expensive than other options.
Cons
Results from these test can give valuable information for preventing CHD, but cannot actually be used to diagnose CHD. This often means that blood testing is used as a first step or in conjunction with other screening testing.
Average cost with and without insurance
With insurance, blood tests are usually at least partially covered by almost all plans. The exact amount covered will of course vary by type of insurance, the test itself, and your deductible. At our local labs, a lipid panel and HS-CRP together can cost around $10-50 with insurance. The Lipid NMR profile tends to be more expensive and can be up to $100 even with insurance.
As always, cash pay prices are going to vary by facility and test. Here in the Tri-Cities, you can get a Lipid panel and HS-CRP for around $50 cash pay. An Lipid NMR profile is around $100 cash pay. Here are Empowered Health, we offer contracted cash pay prices as low as $60 for all three tests.
Resting or Ambulatory ECG
What is it?
An electrocardiogram (ECG) measures the electrical activity generated by the heart as it beats. The record of electrical activity can help identify abnormalities in the rhythm which can be associated with CHD or other heart defects. An ECG can be done while the patient rests, or while they move and walk around, showing how the heart best differs under different situations. Sometimes they are also done at the same time as a stress test to record the heart beat pattern under stress.
Pros
The test is non-invasive as it uses sensors attached to the skin to detect the electrical flow of the heart.
An ECG is a great way of detecting periods that are known as “silent ischemia,” which is when the heart temporarily does not receive enough blood or oxygen without the person noticing any effects. These periods happen often for patients with CHD, but their presence alone is not enough to diagnose CHD.
ECGs tend to be relatively inexpensive.
Cons
ECGs are not an entirely reliable tool for diagnosing CHD specifically due to its high rates for false positives and negatives.
Average cost with and without insurance
ECGs can often be covered by insurance if deemed medically necessary. With insurance it is possible to pay nothing out of pocket but you may have to pay a small facility fee around $10-20.
Cash pay options for ECG tend to be rather affordable. Here at Empowered Health we offer our patients a cash pay price of $25 for ECGs of any kind.
Coronary heart disease is no joke, and getting screened for it before symptoms start can be one of the best ways to prevent serious heart problems later in life.
The choice of how to be screened for CHD is not a one size fits all, however, and the choice can be even harder when you don’t know what your options actually are. If you suspect you may be at risk of having or developing CHD, talk with your doctor about trying one of the above screening methods!