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.”