Screening ECG unnecessary for asymptomatic adults: USPSTF

Laurie Barclay

July 31, 2012

Rockville, MD - The US Preventive Services Task Force (USPSTF) reaffirms its 2004 recommendation against routine ECG screening for asymptomatic adults at low risk for coronary heart disease, according to updated guidelines published online July 31, 2012 in the Annals of Internal Medicine[1].

"[CHD] is the leading cause of death in the United States in both men and women, accounting for nearly 40% of all deaths each year," write USPSTF chair Dr Virginia A Moyer (Baylor College of Medicine, Houston, TX) and colleagues. "More than one million Americans experience nonfatal or fatal MI or sudden death from CHD annually. For some people, this event is the first manifestation of the presence of CHD."

The 2004 USPSTF statement cited a lack of evidence to suggest that ECG screening in asymptomatic, low-risk adults would improve health outcomes, and accordingly, the USPSTF recommended against routine ECG screening for asymptomatic adults at low CHD risk. The task force based its current recommendations on evidence available since 2004.

Benefits and harms

After adjustment for known CHD risk factors, several resting and exercise ECG abnormalities are associated with increased risk for a serious CHD event, according to adequate evidence reviewed by the USPSTF. However, evidence was inadequate to conclude that adding ECG findings to conventional risk-factor evaluation would improve classification of individuals into high-, intermediate-, or low-risk groups to facilitate risk management.

According to the epidemiology and natural history of CHD, as well as treatment regimens using risk stratification, the USPSTF concluded that evidence was inadequate to measure the degree to which additional information from resting or exercise ECG would change risk stratification and associated treatment. Therefore, the USPSTF could not determine whether such additional information would lower the number or severity of CHD-related events.

Potential harms of screening asymptomatic adults with resting or exercise ECG are at least small, according to evidence described as "adequate" by the USPSTF. These harms include unnecessary invasive procedures, overtreatment, and diagnostic mislabeling.

"The USPSTF concludes with moderate certainty that the potential harms of screening for CHD with exercise or resting ECG equal or exceed the potential benefits in asymptomatic adults at low risk for CHD events," the task force writes.

"The USPSTF concludes that the evidence is lacking and the balance of benefits and harms of screening for CHD with exercise or resting ECG in asymptomatic adults at intermediate or high risk for CHD events cannot be determined."

USPSTF recommendations

For asymptomatic adults at low risk for CHD events, the USPSTF recommends against screening with resting or exercise ECG to predict CHD events. To predict CHD events in asymptomatic adults at intermediate or high risk for CHD events, current evidence reviewed by the USPSTF is insufficient to weigh the benefits against the harms of screening with resting or exercise ECG.

"While there is insufficient evidence to determine whether screening adults at increased risk is beneficial, those who are at intermediate risk for CHD events have the greatest potential for net benefit from ECG screening," the task force concludes.

"Reclassification into a higher risk category might lead to more intensive medical management that could lower the risk for CHD events, but it might also result in harms, including medication adverse effects such as gastrointestinal bleeding and hepatic injury. The risk/benefit trade-off would be most favorable if persons can be accurately reclassified from intermediate to high risk."

The USPSTF members have disclosed no relevant financial relationships.

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