Stress testing in low risk chest pain patients---is it always necessary?

Stress testing for patients presenting to the hospital with chest pain, particularly in this era of order sets and templates, has become knee-jerk. For low risk patients under 40 it may not be necessary according to this study:

In our study, a combination of age younger than 40 years, nondiagnostic ECG result, and 2 sets of negative cardiac biomarker results at least 6 hours apart identified a patient group with a very low rate of true-positive provocative testing. Routine stress testing added little to the diagnostic evaluation of this patient group and was falsely positive in all patients who consented to diagnostic coronary angiography (4 of 6 cases).

If nothing else, maybe stress testing could be deferred to out patient testing in some low risk patients who “rule out”, resulting in considerable cost savings to the hospital.

H/T to The Hospitalist.