Every year, over 500 000 US and 120 000 UK residents die of ischaemic heart disease. In 2002, cardiovascular and cerebrovascular disorders accounted for >25% of all deaths in most developed countries.¹ The economic and social burden of atherosclerosis has a global reach. In India, one of the two most populated countries, ischaemic heart disease represents the most prevalent cause of death. Even though the last two decades have seen significant advances in preventive therapeutic strategies, a substantial proportion of individuals with coronary and cerebrovascular disease is diagnosed at the time of presentation with myocardial infarction or stroke. Hence, establishing early accurate diagnosis in those patients who are at risk has great potential for reducing cardiovascular events and extending life expectancy.

In this issue of Heart, Gershlick et al,² from the British Cardiovascular Society Working Group, provide an analysis of the role of current non-invasive tests in patients with known or suspected coronary artery disease. Based on their expert opinion, they issue recommendations for appropriate utilisation. They also forecast implementation of these tests in the UK over the next decade. The value of expert opinion in this topic cannot be understated. At a time when healthcare costs continue to rise at alarming rates, medical imaging has been a focus of attention. The increasing utilisation of medical imaging is driven by multiple factors, including new technological development, patient demand, medical malpractice concerns, physician and hospital reimbursements, and health outcomes. Unfortunately, the benefits of diagnostic testing are more difficult to establish than the benefits of specific therapeutic interventions. Furthermore, the rate of technological development outpaces the collection of health outcome data.

There are five non-invasive …