Thursday, May 13, 2010

Life Line Screening - Worth the Money?

A patient brought in a flyer for Life Line Screening where for $129 an individual can have their carotid (neck) and peripheral (leg) arteries screened for blockage, abdominal aorta for aneurysm (swelling), and osteoporosis. The advertisement claims that "we can help you avoid a stroke" and their logo notes Life Line Screening - The Power of Prevention.

The question is whether having this test is worth your money?

Short answer? No.

Although the flyer correctly indicates that 80 percent of stokes can be prevented, the National Stroke Assocation does not recommend ultrasound as a screening test. Preventing stroke includes quitting smoking, knowing your blood pressure and cholesterol numbers, drinking alcohol in moderation (if already doing so), regularly exercising, and ingesting a low sodium diet. Their is no mention of an ultrasound test. Why?

Because there is NO evidence that it helps save lives in individuals who are healthy and have no symptoms except for the following situations.

The United States Preventive Services Task Force (USPSTF) latest guidelines recommend only screening men between age 65 to 75 years old who have ever smoked to be screened for an aortic aneurysm. If you are in this group, ask your doctor for an ultrasound.

For women, osteoporosis screening should begin at age 65 years old and have a bone density test done. Among the "different bone measurement tests performed at various anatomical sites, bone density measured at the femoral neck by dual-energy x-ray absorptiometry (DXA) is the best predictor of hip fracture." It is unclear how accurate or how good ultrasound of the heel or wrist is compared to the bone density test. If you feel you have other risk factors, like family history, use of steroids for a long period of time, then check with your doctor to see if screening should be done sooner. Otherwise at age 65, all women should be evaluated not with an ultrasound but a bone density test.

USPSTF recommends against screening for peripheral artery / vascular disease (PAD) as well as carotid ultrasound.

Worried about either condition? Ask your doctor. For peripheral vascular disease, particularly when significant, individuals commonly have leg pain when walking. The blockage in the arteries decreases blood flow to the leg muscles when active causing pain. When the person stops walking, the pain resolves. A doctor can determine whether you have PAD by seeing if you have good foot pulses simply by placing fingers on the pedal pulses. If your pulses are normal, then you don't have significant PAD. If the doctor is concerned about your symptoms, he will order an ultrasound which will be covered by insurance.

There is a reason why Life Line Screening in small print writes that they do "not partipate in the Medicare program and the cost of [their] screening servcies is not covered or reimburseable by Medicare" as well as they do "not file insurance claims and the cost of [their] screening services is your responsibility." There is NO scientific evidence these tests can make a difference except for the groups noted above. Since insurance companies only want to cover what is proven, Life Line Screening wants you to pay for an essentially unnecessary test.

Better use for your money? Check your blood pressure and your cholesterol. Quit smoking. Cut down alcohol use if you already drink. Maintain a low sodium diet. To prevent osteoporosis, women should take 1200 to 1500 mg of calcium per day as well as 800 to 1000 IU of vitamin D daily.

For $129? Get a really nice pair of walking shoes. Oh, I don't spend too much money on multivitamins because they aren't worth the money either.

4 comments:

Bill Costa said...

I recently received a flyer from this outfit as well. Thank you for confirming my suspicions regarding the usefulness of this service. When I verified that my (fairly liberal) Health Reimbursement plan wouldn't cover this type of testing, that provided a pretty strong indication that this would not be money well spent.

Anonymous said...

Dr Liu, albeit your article is fairly old I couldn't help but comment on your gross misconception of the facts. First and foremost, you are not a specialist in the field of cardiovascular medicine. Therefore your knowledge of this field is fairly limited compared to that of a Cardiologist or Cardiothoracic Surgeon who has to deal with the more than one million heart attack and stroke victims each year. Primary care physicians have clearly done a poor job at educating and treating their patients on the cardiovascular disease epidemic facing this country today. Data is critical in making optimal health care decisions so what harm is done in arming a physician such as yourself with more data on the patient. Also I find it interesting that the USPSTF, of whom you reference as being experts on the subject, DO NOT HAVE ONE cardiovacular specialist on their panel. If you truly want to provide a factual assessment of the necessity of these screenings then I recommend you review the recommendations of an organization who is well versed on the subject such as the ACC (American College of Cardiology) "not the USPSTF". ACC guidelines clearly indicate the value of these screenings in identifying cardiovascular disease in patients. Perhaps you are ok with the status quo and maybe nearly 800,000 heart attack and stroke deaths each year are acceptable to you and the USPSTF. For me personally I feel that if $129 can allow me to see inside my arteries and find out if I have some plaque or any other cardiovascular issues then it's money well spent. I'm not sure a $129 pair of shoes would get me off the couch but if I found out my arteries were 40% blocked then that would surely motivate me to do something different.

Davis Liu, MD said...

Clearly Anonymous is not comfortable in (a) identifying who they are and (b) fails to understand the role of primary care. My job as a primary care doctor is to prevent disease and illness and to save my patients from needing a cardiologist or a cardiothoracic surgeon.
The ACC guidelines were incorporated as part of this guideline and show there is NO benefit to screening in asymptomatic (no symptoms) on patients.
http://www.guideline.gov/content.aspx?id=34783

The guidelines from the following major professional and health organizations were used for comparison of recommendations on atherosclerotic cardiovascular disease screening:

United States Preventive Services Task Force
American College of Cardiology Foundation/American Heart Association
Society for Vascular Surgery
National Cholesterol Education Program, Adult Treatment Panel III
Screening for Heart Attack Prevention and Education (SHAPE) Task Force
American Diabetes Association
Society of Interventional Radiology

Note the following:
Screening for Peripheral Artery Disease (PAD)

The authors agree with the USPSTF that screening for PAD among asymptomatic adults in the general population is expected to have few or no benefits because of the low prevalence of PAD in this group. There is also little evidence that treatment of PAD at this asymptomatic stage of disease, beyond treatment based on standard cardiovascular risk assessment, improves health outcomes. Most of the literature on PAD pertains to treatment of symptomatic patients, and there is little data directly examining the efficacy of PAD screening among asymptomatic adults in the general population or in higher-risk adults.

Existing evidence supports the use of increased physical activity and smoking cessation to improve outcomes among people with early PAD. However, these interventions should be offered to all patients to encourage healthy lifestyles, and do not necessarily offer additional benefit for people with screen-identified PAD. Finally, screening asymptomatic adults with the ABI could potentially lead to some small degree of harm, including false-positive results and unnecessary workups. Therefore, the potential harms associated with routine PAD screening in asymptomatic adults would exceed the potential benefits.

ACPM does not recommend routine screening for asymptomatic PAD in the general adult population. However, clinicians should be alert to symptoms of PAD in people at increased risk (e.g., people aged >50 years, smokers, and individuals with diabetes) and evaluate patients who have clinical evidence of vascular disease. Therapeutic lifestyle changes including a heart-healthy diet, regular exercise, and smoking cessation should be encouraged in addition to other pharmacologic risk reduction strategies for individuals at risk for PAD.

The above recommendations are as of March 2011.

Chris Summers said...

I am a 57 year old white male and I see a cardiologist for elevated blood pressure, for which he prescribes medication. I see him once a year at which time he does a cardiogram, listens to my heart, takes my pulse, asks health questions, etc. For the past 2 years he has encouraged me to do this battery of tests and says he and his wife do them every other year or so. He has no affiliation with the company that does the tests and he tells me in his opinion the tests are worth the costs. I recently got the flyer from the company offering these tests in conjunction with a major hospital in my area and for $150 I think I will go ahead and do the tests. Maybe it will show I have nothing wrong but I feel if it brings peace of mind and makes my cardiologist happy it is worth it, he indicated he would like to see the results by the way.

Incidentally I originally had a GP/primary care doctor several years ago that I liked, he was the one who found my blood pressure issue. Sadly I moved and tried 2 different PC doctors so I could continue to get my medications but did not like either one, both wanted to see me every 3 to 6 months in their office just to approve refills, etc. My cholesterol numbers were boderline and they both also were into pushing me towards drug therapy (statins) instead of even suggesting I just get more exercise or watch what I ate. I took it upon myself to make lifestyle changes and my cholesterol improved to where the cardiologist is happy and I feel much better about my weight, etc. In my situation, I felt the PC doctors were relying too much on prescribing popular drugs pushed by pharmaceutical companies unnecessarily and requiring me to come in just to build income for their practices. After trying both for a year each I quit seeing them and am happy I did. I see a cardiologist as mentioned and a pulmonary doctor for my asthma. I see both just once a year, get a good exam by a specialist in their field and even though I pay a bit more in my copay I am very happy.

Thanks for considering my story and opinion

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