Go to content

Increases in cardiac tests outpacing growth of heart disease


The use and cost of cardiac tests have increased significantly in Ontario, outstripping demographic shifts and increases in heart disease, a new study from the Institute for Clinical Evaluative Sciences (ICES) published in the current issue of the journal Circulation shows.

“Although healthcare expenditures continue to rise in Canada, up until now no one has examined how much these increases are attributable to the rise in the use of cardiac technology,” said lead author and ICES scientist Dr. David Alter.

“As heart disease remains the leading cause of death in Canada, and cardiovascular technology accounts for greater healthcare expenditures than technology for any other disease, this is an issue that deserves our immediate and urgent attention.”

The ICES study is matched by a second paper published in the same issue of Circulation, which examines the dramatic rise of cardiac procedures in the United States since 1992, as well as an accompanying editorial.

To conduct their study, ICES investigators examined the use of echocardiography (an imaging procedure to evaluate blood flow across the heart’s valves), stress testing (how the heart responds to stress), angiography (an x-ray visualization of the internal anatomy of the heart), angioplasty (a diagnostic procedure conducted by inserting a small, thin catheter through an artery in the arm or groin through the artery to the heart), and bypass surgery among Ontario adults between 1992 and 2001. Utilization rates were examined by age, gender, and socioeconomic status.


  • The use of all cardiac technologies demonstrated significant exponential growth over the study period, outstripping growth rates in the burden of cardiac disease, and demographic shifts in the population.
  • Annual cardiac technology costs increased by nearly two-fold over the ten-year study period, and cumulatively accounted for over $2.8 billion in expenditures in Ontario alone.
  • Annual increases in the utilization of cardiac tests and procedures were disproportionately higher among the elderly and women, but were similar across socioeconomic subgroups.
  • Increases in utilization appeared to reflect referrals toward higher-risk populations.
  • While the overall rates of cardiac technology use in Canada were less than that seen in the U.S., the annual growth rates were similar between the two countries.

“The proliferation and use of cardiac technology services in North America can be likened to that of a speeding train, with Canada at the ‘caboose’ and the U.S. at the ‘engine’, both surging along similar tracks facing similar challenges,” said Dr. Alter.

“While our study cannot answer questions about whether these changes reflect the appropriate use of these technologies in this country, the substantial growth of cardiac technology will likely present significant challenges to the sustainability of Medicare in Canada, especially given the uncertainty as to whether the rise in total cardiac technology expenditures translates into significant outcome benefits in the population.”

Author affiliations: ICES (All authors); Division of Cardiology, Schulich Heart Centre, Sunnybrook and Women’s College Health Sciences Centre (Dr. Alter); Clinical Epidemiology and Healthcare Research Program Sunnybrook and Women’s College site (Dr. Alter), and Department of Health Policy, Management and Evaluation (Dr. Stukel), University of Toronto.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.


  • Julie Dowdie
  • Media Relations Officer, ICES
  • (416) 480-4780 or cell (416) 432-8143


Contributing ICES Scientists

Research Programs

Associated Sites

Read the Journal Article