June 23rd, 2014

Mobile Cardiovascular Screening Programs Come Under Fire

The consumer group Public Citizen has urged 20 hospitals to sever their involvement in a mobile cardiovascular screening program. The HealthFair Cardiovascular Screening Packages are unethical, mislead consumers, and do more harm than good, according to Public Citizen.

In a statement, the president of the American College of Cardiology, Patrick O’Gara, said that “the questions raised about screening have some merit…. we do not recommend broad and untargeted screening.”

The program, says Public Citizen, “peddles inexpensive cardiovascular disease screening packages to people living near the hospitals and institutions without identifying who has relevant risk factors that would make each of the screening tests medically appropriate. HealthFair’s basic cardiovascular screening packages include six tests that, among other things, take pictures of the heart, measure its electrical activity and look for blockages in arteries.”

“The promotions rely on fearmongering and erroneously suggest that for most adults in the general population, these screening tests are useful in the prevention of several potentially life-threatening cardiovascular illnesses – including heart attacks, strokes and ruptured abdominal aortic aneurysms – and make them sound like an appealing bargain,” according to Public Citizen. Among the harms cited by Public Citizen are false-positive results or the discovery of inconsequential abnormalities. “Both circumstances can lead to additional unnecessary and risky tests and treatments that will harm some people, cause unfounded anxiety, and cost patients and insurance companies.”

Here is O’Gara’s response to Public Citizen:

The questions raised by Public Citizen about mass screenings have some merit. Medical screenings can be hugely beneficial to patients, but they are also costly and can contribute to some of [the] issues of false positives and overdiagnosis outlined in the letters. To that end, both the ACC and the American Heart Association have joint guidelines that offer recommendations to guide physicians in making decisions with individual patients about their risk for heart attack and stroke. Other than assessing blood pressure and serum cholesterol, being attentive to diabetes and promoting a healthy weight with regular exercise, we do not recommend broad and untargeted screening.

From the patient perspective, decisions about the need for additional testing should be based on each patient’s circumstances. The College was one of the first associations to participate in the Choosing Wisely campaign, which encourages physicians and patients to discuss the costs and benefits of often overused tests and procedures. In addition, the College’s CardioSmart initiative is focused on educating patients and caregivers about cardiovascular disease, treatments and prevention.

Note: Comments on this news story are closed, but please join the discussion about this topic over at Ethan Weiss’ post, where he discusses the consequences of unethical and unnecessary cardiovascular screening.

One Response to “Mobile Cardiovascular Screening Programs Come Under Fire”

  1. Jean-Pierre Usdin, MD says:

    Thank you for these important informations
    Here again the question remains:
    Is general check up helpful (“cost-effective”)?
    What is the NNT? I suppose nobody can (and will never be able to)answer.
    But reading many of your reports (special thanks to Richard Lehman) We know that, not only these programs cost a lot of money (to public and employers who want to be “sure” their coll. are in “good health” ) but the number of incidental findings (now designed in french langage as incidentalomes) are so important and a major source of fear plus chains of useless and harmful procedures: X Rays …
    This statement to consider these check-up unethical, is a very good position from ACC and AHA. Primary prevention is important as campain against tobacco, overweight… but the patient’s symptoms should remain in the center of our medical practice.
    We are not patient-hunters but patient-sitters!