ECG Screening Gains No Traction in Draft USPSTF Recommendations

Patrice Wendling

January 05, 2018

A new draft recommendation from the US Preventive Services Task Force (USPSTF) neither endorses nor rejects the use of ECG screening for atrial fibrillation (AF) in asymptomatic adults at least 65 years of age[1].

The agency found evidence was inadequate to determine whether screening with ECG and subsequent treatment in older asymptomatic adults is more effective than opportunistic screening or usual care, which may include the simpler methods of pulse palpation or heart auscultation.

"At the same time, the harms of diagnostic follow-up and treatment prompted by abnormal ECG results are well established. Given these uncertainties, it is not possible to determine the net benefit of screening," according to the document, released December 19, 2017.

A separate draft recommendation released at the same time also cites insufficient evidence for the USPSTF's decision to stand by its 2012 recommendation against ECG screening for cardiovascular disease in low-risk asymptomatic adults.

The task force says current evidence was inadequate to determine whether the incremental information provided by resting or exercise ECG, beyond that obtained using traditional CVD risk factors, can be used to guide treatment decisions or ultimately reduce CVD events.

There was, however, adequate evidence that screening with resting or exercise ECG leads to harms that are "at least small and may be moderate" such as unnecessary invasive procedures, overtreatment, and labeling.

"The USPSTF concludes with moderate certainty that the potential harms of screening with resting or exercise ECG to prevent CVD events equal or exceed the potential benefits in asymptomatic adults at low risk of CVD events," the document states.

For adults at intermediate- or high-risk, the task force says evidence is also insufficient to assess the balance of benefits and harms of routine screening.

Still, "For persons in certain occupations, such as pilots and operators of heavy equipment, for whom sudden incapacitation or death may endanger the safety of others, considerations other than the health benefit to the patient may influence the decision to screen with ECG to prevent CVD events," the document states.

The USPSTF notes the American College of Physicians also recommends against resting or stress ECG screening for CVD in asymptomatic low-risk adults. The American College of Cardiology suggests exercise ECG is rarely appropriate in asymptomatic low-risk adults, may be an appropriate option for intermediate-risk adults, and is appropriate for high-risk adults.

With regard to ECG screening for AF, the American Heart Association and American Stroke Association have suggested active screening using pulse assessment followed by ECG can be useful in the primary care setting among patients older than age 65.

The task force calls for additional research of ECG screening for CVD and AF, and highlights several ongoing trials that may help fill the evidence gaps in the AF field. They include STROKESTOP involving systematic ECG screening, SCREEN-AF examining home-based screening in the elderly, IDEAL-MD looking at the MyDiagnostick device, and D2AF comparing pulse palpation, electronic sphygmomanometer with AF detection, and a handheld, single-lead ECG.

Public comments are being taken on the two draft recommendation statements through January 22, 2018.

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