American College of Cardiology

View all recommendations from this society

Updated January 11, 2021

Avoid performing stress testing or advanced cardiac imaging to diagnose ischemic heart disease in the initial evaluation of patients who do not have cardiac symptoms and are not at high risk.

Asymptomatic, low-risk patients account for up to 45 percent of unnecessary “screening” for ischemic heart disease. Testing may be considered when
high risk markers are present, such as diabetes in patients older than 40 years or peripheral arterial disease

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American College of Cardiology (ACC) asked its standing clinical councils to recommend between three and five procedures that should not be performed
or should be performed more rarely and only in specific circumstances. ACC staff took the councils’ recommendations and compared them to the ACC’s existing appropriate use criteria (AUC) and guidelines, choosing items for the five things list that were either Rarely Appropriate AUC recommendations or Class III guideline recommendations. The ACC’s Science and Quality Committee then reviewed and approved the final five items. ACC’s disclosure and conflict of interest policy can be found at


Wolk MJ, Bailey SR, Doherty JU, Douglas PS, Hendel RC, Kramer CM, Min JK, Patel MR, Rosenbaum L, Shaw LJ, Stainback RF, Allen JM. ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Stable Ischemic Heart Disease. Journ Am Coll Cardiol. 2014 Feb;63(4);380-406.