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USPSTF 2018 recommends against screening resting/exercise ECG for asymptomatic adults at low risk of CVD (D recommendation)
Clinical Question
Should primary care clinicians recommend resting or exercise electrocardiography for asymptomatic adults at low risk of cardiovascular disease?
Bottom line
In this updated 2018 review, the U.S. Preventive Services Task Force recommends against screening with resting or exercise electrocardiography (ECG) in asymptomatic adults at low risk (10-year event risk < 10%) of cardiovascular disease (CVD) events (D recommendation). The task force also concludes that evidence is insufficient to assess the benefits and harms of screening ECG in asymptomatic adults at intermediate or high risk of CVD events (I statement). These recommendations are unchanged from the 2012 task force recommendations on screening resting or exercise ECG. 2c
Reference
Study design: Practice guideline
Funding: Government
Setting: Population-based
Synopsis
In this updated 2018 version, the task force found 2 randomized trials reporting no reduced risk of CVD events or mortality from screening with exercise ECG in adults, aged 50 to 75 years, with pre-existing diabetes. Additional evidence from cohort studies found that adding ECG results to traditional CVD risk factors did not reliably and consistently improve risk assessment for future CVD events in asymptomatic adults at low risk of CVD events (10-year CVD event risk < 10% calculated by Pooled Cohort Equations). High-quality evidence for a change in risk management that reduces CVD events is also lacking in adults at intermediate or high risk of CVD events. Possible harms of screening include adverse effects of subsequent invasive testing, overtreatment, and labeling. The American Academy of Family Physicians, the American College of Physicians, and the American College of Preventive Medicine all recommend against routine screening with resting or exercise ECG in asymptomatic low-risk adults. These recommendations do not apply to persons in certain high-risk occupations, such as airline pilots and operators of heavy equipment.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
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The problem with these recommendations is this: if you don’t look, you don’t see. For instance, I have a long QT. I wouldn’t have known it without screening. Another doctor standing in wanted to prescribe a macromide ab. Now I know about long QT and macrolides and torsadde-de-points fatal arrhythmias and a bad outcome was averted. Who are these physicians to say screening is of no value? I am living proof of the opposite
I wish many of my specialist colleagues were as aware of this as I am. Low specificity, high sensitivity in low probability cases leads to lots of false positives with poor outcomes from inevitable invasive follow up.
Perhaps we may want to do a study on whether there is any benefit to do exercise ECG on asymptomatic high risk ( eg DM ) individual.