July 30th, 2012

USPSTF Maintains Recommendation Against ECG Screening of Asymptomatic, Low-Risk Adults

The  U.S. Preventive Services Task Force (USPSTF) has reaffirmed its 2004 recommendation against ECG screening for asymptomatic adults who are already at low risk for coronary heart disease (CHD). The task force also concluded that there was insufficient evidence to assess the risks and benefits of ECG screening in asymptomatic people at intermediate or high risk for CHD. The report has been published in the Annals of Internal Medicine.

For asymptomatic people at low risk, the report concludes that additional information obtained from resting or exercise ECG tests would be unlikely to change their risk assessment or to improve their health outcomes. By contrast, the tests are associated with “significant possible harms,” most importantly related to “exposure to potential adverse effects of invasive tests.”

The USPSTF weighed the evidence of the risks and benefits of ECG screening, but it did not include the cost of ECG screening as part of its analysis. The task force also recommends that physicians “individualize decision making to the specific patient or situation.”

The USPSTF notes that their recommendations differ slightly from current ACCF/AHA guidelines, which state that resting ECGs are “reasonable for cardiovascular risk assessment in asymptomatic adults with hypertension or diabetes.” In addition, 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.”

3 Responses to “USPSTF Maintains Recommendation Against ECG Screening of Asymptomatic, Low-Risk Adults”

  1. Robin Motz, M.D., Ph.D. says:

    I have heard the following argument in favor of an EKG at the first meeting for an office physical: Few if any patients have a completely “normal” EKG—RBBB, IVCD, inferior septal q’s, J-point elevation, etc. Why not have a baseline EKG so that when the patient presents with chest pain it can be determined if the observed “abnormality” is new?

  2. Anil Virmani, MD, DRM says:

    I agree with Robin. A baseline ECG in all will not only reassure the patient of absence of any gross abnormality or pick up an incidental finding, which maybe useful later on, when comparing with new ECG.

  3. Dheeraj Bhatt, MBBS,MD,DM says:

    unnecessary investigations increase the healthcare costs.Reassuring patients is not easy, the same arguments can be given for doing ECHO, Stress Test, routine ultrasound abdomen, routine chest x ray. and that too every year, like we end up doing in preventive health check ups in India.