Adults at low risk for heart attack and other coronary heart disease events and who have no symptoms of heart disease should not be routinely screened with resting or exercise electrocardiography (ECG), according to the US Preventive Services Task Force. The recommendation, appearing today in the Annals of Internal Medicine, is an update to the task force’s similar 2004 statement that considers studies on the topic published since that time.
Coronary heart disease is the leading cause of death in the United States for both men and women, accounting for nearly 40% of all deaths annually. Each year more than 1 million people in the United States experience nonfatal or fatal heart attacks or sudden death from heart disease.
The conventional tool used by physicians to assess a patient’s heart disease risk is the Framingham Heart Study risk assessment tool, which helps identify individuals at high, intermediate, or low risk of having a heart event in the next 10 years based on such factors as age, sex, total cholesterol and high-density lipoprotein cholesterol (HDL) levels, systolic blood pressure, and smoking. Those at low risk have a 10% or less chance of having a heart event over the next 10 years. At issue is whether ECG screening would provide information that would enable them to identify additional patients at risk and make it possible to treat such patients and further reduce the number of heart attacks or sudden cardiac death.
The task force also considered the potential for harm among asymptomatic adults, notably harms associated with follow-up testing or interventions when a screening ECG finds abnormalities. The task force found studies showing that up to almost 3% of asymptomatic adults who had abnormal findings on an exercise ECG test underwent an angiography, a procedure associated with a number of potential risks, including heart attack, stroke, and an allergic reaction to dye or medication used during the procedure.
Additionally, the task force said that among adults identified by conventional risk factors as being at intermediate or high risk of a heart attack or other coronary heart disease event, evidence was insufficient to assess the balance of benefits and harms in using ECG screening to further predict coronary heart disease events. The task force noted such individuals should already be receiving appropriate treatment, which includes a combination of interventions such as appropriate diet and exercise, lipid-lowering medications, aspirin, hypertension management, and tobacco cessation.