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Nov 29th 2022

Q&A: eviCore’s Dr. Sharon Nichols Shares the Importance of Evidence-Based Cardiovascular Care for Patients

Dr. Sharon Nichols, a board-certified cardiologist, is eviCore’s Executive Medical Director for Cardiovascular Services. We sat down with her to understand how her team helps patients get evidence-based cardiovascular care to meet their needs.

Why is eviCore’s Cardiovascular Solution Important?

Our Cardiovascular solution helps make sure patients get medically appropriate cardiovascular care, including imaging like cardiac CTs and MRIs, tests like stress tests and echocardiography, and implantable devices like pacemakers and defibrillators. This is crucial because when a patient gets cardiovascular care that doesn’t follow evidence-based medical guidelines, it doesn’t do them any good – and can even be harmful. 

How Often Does Inappropriate Cardiovascular Care Occur?

It occurs a significant amount of the time, which isn’t good for patients. For example, it’s estimated that about a third of cardiac stress tests with imaging don’t meet current evidence-based guidelines.[1] That means one patient out of every three doesn’t need the test!

This is meaningful for a few reasons. First and foremost, the patient may not get a definitive diagnosis for what’s going on with them because it’s not the right test. Next, these unnecessary tests can create false alarms that may lead to more involved and invasive examinations, such as a coronary angiography. Moreover, did we mention the cost? An imaging stress test costs $500 - $2,000, depending on where it is done, and the average cost of a coronary angiograph is nearly $8,500.[2] Additionally, a single coronary angiograph can expose the patient to as much radiation as 600 - 800 chest X-rays.[3]

To give you one more example, nearly a quarter of implantable cardioverter defibrillators (ICDs) are implanted without adhering to evidence-based guidelines.[4] While ICDs can certainly help prevent death in the cardiovascular patients with advanced heart failure who need it, the risks of in-hospital death and post-procedure complication are significantly higher in patients who receive non-evidence-based ICDs.[5]

Doesn't the Doctor Know What Care is Needed for Their Patient?

Medical information is exploding at a rate that makes it tough for providers to keep up. To give you a sense of the magnitude, a recent survey found that more than two-thirds of physicians feel overwhelmed by the amount of information they have to keep up with.[6] As a result, there can be significant knowledge gaps when it comes to caring for patients in ways that align with the latest medical evidence.

That’s why the work we do at eviCore is so essential. Our evidence-based clinical guidelines are used to help ensure that the cardiovascular care that patients receive is evidence-based. This means they get better possible health outcomes, receive a definitive diagnosis, and face fewer health risks and reduced health care costs.

How Does eviCore Make Decisions that Align with Medical Best Practices?

Our medical guidelines, mentioned previously, ensure we make decisions that will provide the best possible health outcome for patients. The guidelines are based on information from medical societies like the American College of Cardiology ®, along with recently published, peer-reviewed medical studies. They’re created by physicians certified in the specific specialty – in this case, cardiovascular care – and they’re reviewed by external experts. Our guidelines are updated at least twice a year and are available to anyone visiting eviCore’s website.

We use these guidelines to help determine if a requested cardiovascular imaging test, intervention, or device implantation, like pacemakers and defibrillators, aligns with what the best medical science has to tell us.

Who Makes These Decisions at eviCore?

We have a team of more than 45 board-certified cardiologists and over 500 specialty trained clinical nurse reviewers who focus just on our Cardiovascular solution. Their sole job is to help ensure better outcomes for our patients.

How are you Helping Make Sure Patients get the Care they Need Quickly?

We’ve invested a lot of time and resources in streamlining and automating our processes to help make our role as seamless as possible. For more information, visit: eviCore intelliPath®.

You can learn more about eviCore’s Cardiovascular solution on our website.


[1] Ladapo JA, Blecker S, Douglas PS. Physician decision making and trends in the use of cardiac stress testing in the United States: an analysis of repeated cross-sectional data. Ann Intern Med. 2014 Oct 7;161(7):482-90. doi: 10.7326/M14-0296. PMID: 25285541; PMCID: PMC4335355.

[2] Choosing Wisely, “Stress Tests After a Stent Procedure,” https://www.choosingwisely.org/patient-resources/stress-tests-after-a-stent-procedure/. Accessed 15 Jul 2022.

[3] Choosing Wisely, “EKGs and Exercise Stress Tests,” https://www.choosingwisely.org/patient-resources/ekgs-and-exercise-stress-tests/. Accessed 15 Jul 2022.

[4] Al-Khatib SM, Hellkamp A, Curtis J, Mark D, Peterson E, Sanders GD, Heidenreich PA, Hernandez AF, Curtis LH, Hammill S. Non-evidence-based ICD implantations in the United States. JAMA. 2011 Jan 5;305(1):43-9. doi: 10.1001/jama.2010.1915. PMID: 21205965; PMCID: PMC3432303.

[5] Duke University, “Implantable Heart Defibrillators Too Widely Used in High-Risk Patients,” https://corporate.dukehealth.org/news/implantable-heart-defibrillators-too-widely-used-high-risk-patients. Accessed 15 Jul 2022.

[6] Doximity, “Physician Learning Preferences,” https://c8y.doxcdn.com/image/upload/Press%20Blog/Research%20Reports/Doximity-Physician-Learning-Report-2022.pdf. Accessed 15 Nov 2022.