CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

March 17th, 2015

ACP Recommends Against Screening Asymptomatic Adults for Cardiac Disease

The American College of Physicians has recommended that clinicians should not screen low-risk, asymptomatic adults for heart disease.

In guidelines published in the Annals of Internal Medicine, the ACP says that adults with a 10-year risk for coronary heart disease events under 10% should not undergo screening with resting or stress electrocardiography, stress echocardiography, or stress myocardial perfusion imaging. There is no evidence that these tests improve patient outcomes, but they can lead to increased costs and possible harms, such as radiation exposure and unnecessary follow-up tests.

Instead, clinicians should focus on strategies to modify risk factors — such as smoking, diabetes, hypertension, and hyperlipidemia — and encourage physical activity.

Categories: Cardiac Imaging, Prevention


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One Response to “ACP Recommends Against Screening Asymptomatic Adults for Cardiac Disease”

  1. William L Blanchet, MD says:
    March 30, 2015 at 11:33 pm

    Although I firmly agree that stress echo or stress perfusion imaging is obviously of limited value in screening for heart disease risk as most heart attacks occur in non-obstructed vessels, I strongly disagree with the assertion that we should do no screening other than traditional risk factors.

    In the MESA heart study, 90% of the women were considered “low risk” by Framingham standards. 30% of them had calcium on their ultrafast CT heart scan and were found to be at significantly increased risk.

    I suggest that everyone takes a look at the new movie ” The Widowmaker (2015)”. It gives insight to how non-medical people respond to our willingness to ignore the significant inaccuracy associated with traditional risk factors. While we seem to be happy allowing 150,000 Americans to die each year from their first symptom of undiagnosed coronary disease, normal people take issue with this.