So, it appears that in the best-case scenarios, chest pain syndromes should be assessed accurately with as appropriate tests as possible, if cost is not a concern, because these would offer the best long-term outcomes for patients with symptoms. Some 20% of these patients would fare better clinically, when they undergo appropriate NIT. The odds-ratio benefits in terms of generating more invasive testing or revascularization is some 0.2% less. More importantly, there appears to be fewer longer-term unstable coronary syndromes and cardiovascular mortality. We await more health audit cost-benefits analyses to see if these would justify advocating more routine cardiac testing in other countries with different socioeconomic bases.

This editorial is to help raise some questions as to the cost vs. benefit balance of what we as cardiologist have been called upon to apply as healthcare providers. We need to scrutinize the extravagance or wasteful use of clinical care algorithms that now besiege the cardiovascular fraternity. We are called upon to exert greater prudence in the use of finite healthcare resources.

Many authoritative cardiac societies through its ever more deterministic guidelines and position statements, are redefining and benchmarking ever more diagnostic and therapeutic strategies. These are resultant suppositions of more and more tightly controlled studies that show small incremental benefits, as we strive to be more accurate and precise in our dealing with this nebulous syndrome.

Unfortunately, the wider adoption of such evidence bases has increasingly created demands for greater utilization of costly tests, and innovative devices that severely test the resources of most healthcare systems. Of course, our duty as physicians, is to our patients, whom we wish to manage the best we can. But our patients would ultimately also be those who have to shoulder the mounting cardiovascular health risks and ultimately the healthcare costs for society, as a whole. Thus, we must learn to be more prudent or even be more parsimonious in our clinical decision-making.^{6, 7}

Many doctors are concerned that we should be rationing healthcare when we use the term parsimonious or ‘being stingy’. However, when discussing medical ethics in the context of healthcare policies and costs, Dr Virginia Hood (president of the American College of Physicians clarified that “parsimonious is a good word in the sense that it means that you use only what’s necessary,” and that she did not “see any particular problems with that. Maybe it has some connotations where people think frugality or being parsimonious is the same as being mean or inadequate.”⁸

For resource-poorer nations, more parsimonious, yes, more appropriate, and more cost-effective approaches are called for. Each nation has to weigh its own health efficiencies, as well as its ability to provide easy access, modern infrastructure, sufficient manpower expertise and budget enough allocations to finance its own healthcare system. Even for richer nations, unfettered wide utilization of health resources can be devastating as these would ultimately lead to reduced access because of inability to pay, including the extremely high costs of insurance, whether through self-paying, employer-benefit or state-paid schemes.⁹

Does a healthcare expenditure of 18% of the nation’s gross domestic product, make sense?¹⁰ Or can we all work more sensibly and effectively to moderate this escalating cost of diminishing returns? In the field of rapidly more technically advanced management of cardiovascular ailments, cardiologists have to take some lead in moderating the exuberance in healthcare costs escalation.