Cardiac stress test, which is commonly referred as exercise electrocardiogram in medical terms, is prescribed by the doctor to know the level of stress an individual’s heart can bear. Coronary artery disease causes 20% of the death in developed country.1 The chest pain also known as angina. Angina is caused by blockade of coronary artery, which supplies oxygenated blood to heart. The coronary artery blockade is often not noticed when individual is in rest position or maintains very low active lifestyle. Thus, blockage of the heart blood supply and other issues of the heart remain unidentified when individual is not involved in any activities and maintains very low active life style. However, when the heart of the patient pumps faster (tachycardia) resulting in increased heart rate and chest pain (angina) then it becomes easy to identify blockade as one of the cause of angina. The cardiac stress test is performed under the supervision of experienced nurse and cardiologist.
What is the Cost of Cardiac Stress Test?
Broadly two types of costs are involved in cardiac stress test; one is the cost of the facility where cardiac stress test is performed (facility fee) and second is the cost of cardiologist fee to evaluate the cardiac stress test results (physician fee).
The insurance provider will deduct co-pays and deductibles to pay final amount of facility and physician fees for cardiac stress test. The deductible and co-pays are paid by individual. Patients under 65 years are covered by private insurance provider and those over 65 years are covered by Medicare as well as private insurance provider. Patient who are covered by private insurance provider are yet expected to pay around $300-$400 for facility fee and $ 30 to 40 for physician fees to cover co-pays or deductibles. Medicare pays 80% of the scheduled amount and remaining 20% of the amount, which is not covered by Medicare is paid by individual’s private insurance provider. Most Medicare patient pay annual fee to private insurance provider to cover 20% of the facility and physician fees, which is not covered by Medicare. Uninsured patients often may not get tested unless authorized by State funded Medicaid. Most specialists do not participate in taking care of Medicaid patients. If individual decides to pay for cardiac stress test out of pocket, then the facility fee could be $ 1,500 to $ 5,000 and physician fee could be $ 250 to 500. These cardiac stress test prices are often negotiable. Cardiac stress test cost varies with geographical location and severity of patient’s condition.
What Happens During a Cardiac Stress Test?
The electrocardiogram equipment and all hardwires are tested prior to beginning of the test. Usually cardiac stress test is performed on treadmill and in few cases stationary bike is used. Prior to the cardiac stress test, electrode plates are stuck to the skin of the chest wall as well as arms and legs over the gel. The heart is monitored and recoded prior to beginning of exercise as a resting test. Doctor performing the test then requests the individual to walk on treadmill or ride a stationary bicycle. As the cardiac stress test progresses doctor often may request the patient to increase the intensity of the exercise. The heart rate is triggered to go faster by making the patient walk or run on the treadmill or by cycling a bicycle in stationary position. During the cardiac stress test, intensity of the exercise is gradually increased to identify the stress level patient’s heart can tolerate. Actually duration of the cardiac stress test last for just 15-20 minutes but total time duration taken including the preparation for cardiac stress test is almost 2 hours.
On each step of increase speed of treadmill or resistance of stationary bike, doctor or technician records the heart rate of the patient. Patient is suggested to perform the exercise until they start feeling chest pain or completely exhausted. Doctor also keep on taking feedback from the patient in regular intervals to know how they are feeling. The most vital part of the test is to evaluate the signs of chest pain. The test is discontinued once physician sees the signs of diaphoresis (sweating, low blood pressure and shortness of breath) or chest pain. Patient who are exhausted but had no signs of chest pain are observed in recovery room and discharged home once heart rate and blood pressure comes to normal level. Those patients who had signs of diaphoresis and chest pain are scheduled for further study like echocardiogram and coronary angiogram.
The stress test may involve injection of medications to increase heart rate in patients who are unable to perform exercise. Occasionally such medications are mixed with radioactive substance. The stress test is known as nuclear cardiac stress test when radioactive dye is injected along with medication to increase heart rate. The radioactive substances facilitate and projects clear and improved images of the heart, which is observed on ultrasound scanning machine. These images make it easy to evaluate the contracting functions of the heart. An ultrasound image machine is integrated with high definition camera. The images are examined by the cardiologist to evaluate heart condition. The pre and post stress images are compared. However, nuclear cardiac stress test is not recommended to some high risk specific patients.
Factors That Can Increase Cardiac Stress Test Costs
There are several test performed to evaluate coronary artery disease resulting in chest pain and angina. The test performed are Stress echocardiogram (ECHO), single photon emission computer tomography (SPECTS) and stress cardiac magnetic resonance imaging (C-MRI).2 The published data suggest stress electrocardiogram study is less expensive and equally comparable to other tests. The cost of cardiac stress test though increases in few patients, who are unable to walk or run on treadmill as well as ride on stationary bicycle because of moderate to severe arthritis. These patients are given intravenous medications to increase the heart rate. The cost of cardiac stress test increases because of longer duration of stay at facility, additional services like putting intravenous catheter, running normal saline solution and cost of medications. The additional cost of the cardiac stress test could be around $100 to $500. If radioactive substance is induced in the body of patient, then cost increases even more up to additional $ 900 to $ 1,000. The cost of the cardiac stress test is indeed expensive but early diagnosis of angina or coronary artery disease can save the life. The test gives a very clear picture of how the heart functions and to what extent heart of the patient can bear stress. This helps doctors to identify the condition of heart and how its performance can be improved.
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- What is the Purpose of a Stress Test?
- How Should One Prepare For a Stress Test?
- How Much is a Stress Test?
- What is a Nuclear Stress Test & How Much Does It Cost?
- What is a Chemical Stress Test for a Heart & How is it Done?|What Does Chemical Stress Test Report Indicate?
Chronic coronary artery disease: diagnosis and management.
Cassar A1, Holmes DR Jr, Rihal CS, Gersh BJ., Mayo Clin Proc. 2009 Dec;84(12):1130-46.
Long-term Cost-Effectiveness of Diagnostic Tests for Assessing Stable Chest Pain: Modeled Analysis of Anatomical and Functional Strategies.
Bertoldi EG1,2,3, Stella SF2,3, Rohde LE3, Polanczyk CA2,3., Clin Cardiol. 2016 May;39(5):249-56.