MONDAY, July 30, 2012 (MedPage Today) — The U.S. Preventive Services Task Force continues to recommend against using electrocardiography (ECG) to screen asymptomatic adults at low risk for coronary heart disease.
The recommendation, published online in the Annals of Internal Medicine, is consistent with the task force's 2004 guidance and is based on a update of a review published last September that showed a lack of evidence supporting a reduction in coronary heart disease events from screening a low-risk population.
The guidance applies to men and women who do not have any symptoms and have not received a diagnosis of cardiovascular disease. According to the Framingham Adult Treatment Panel III calculator, individuals with a 10-year risk of cardiovascular events of less than 10 percent are considered to have a low risk.
After reviewing studies published since 2004, the authors concluded that resting ECG can detect abnormalities that are related to a greater risk of serious coronary heart disease events — including ST segment and T wave abnormalities, left ventricular hypertrophy, left axis deviation, and bundle branch block.
They also concluded that exercise ECG can detect abnormalities associated with subsequent cardiac events including ST depression with exercise, failure to reach 85 percent or 90 percent of maximum predicted heart rate, and abnormal heart rate recovery after exercise.
However, they concluded that the information added by ECG is unlikely to change risk stratification based on traditional cardiovascular risk factors or spur interventions to prevent clinical events.
In addition, there was evidence that screening asymptomatic, low-risk adults could result in some harms, such as unnecessary invasive testing and procedures, overtreatment, and labeling.
"Therefore, the USPSTF concluded with moderate certainty that screening ECG provides no net benefit to asymptomatic, low-risk patients," the guidance stated.
Guidelines from the American College of Cardiology and the American Heart Association suggest that a resting ECG is "reasonable for cardiovascular risk assessment in asymptomatic adults with hypertension or diabetes."
They also suggest that an exercise ECG "may be considered for cardiovascular risk assessment in intermediate-risk asymptomatic adults (including sedentary adults considering starting a vigorous exercise program), particularly when attention is paid to non-ECG markers such as exercise capacity."
The USPSTF document also addressed the use of ECG to screen asymptomatic adults at intermediate or high risk, with the task force concluding that there is insufficient evidence to recommend for or against the practice.
The authors noted, however, that certain factors should be taken into account when a clinician is considering screening adults in those categories with ECG, including potential harms and preventable burden.
Individuals at intermediate risk, for example, likely have the greatest potential to derive a benefit from screening because getting placed into a higher risk category might lead to more intensive medical management that has been shown to lower the risk for coronary heart disease events.
Those already at high risk based on traditional cardiovascular risk factors, on the other hand, should already be receiving intensive management.
An individual's occupation can also be considered because screening might make sense for people whose sudden incapacitation or death could harm others, including pilots and heavy equipment operators.
Virginia A. Moyer, MD, MPH, from Baylor College of Medicine in Houston, was the chair of the task force when this recommendation was finalized.