USPSTF Finds Insufficient Evidence For Preventative ECG Screening in Asymptomatic, Low-Risk Adults

The U.S. Preventive Services Task Force (USPSTF) recommends against preventative screening with resting or exercise electrocardiography (ECG) in asymptomatic adults at low risk of cardiovascular disease events in an updated recommendation statement published June 12 in the Journal of the American Medical Association (JAMA).

The USPSTF's decision to uphold the 2012 recommendation against screening for coronary heart disease with ECG in adults at low risk follows analysis of an evidence report and systematic review from Daniel E. Jonas, MD, MPH, et al., also published June 12 in JAMA. However, the evidence for screening in adults at increased risk and the evidence for frequency of harm resulting from screenings remain uncertain.

Two random clinical trials included in the review found no significant improvement in health outcomes for screening with exercise ECG in adults aged 50 to 75 years when compared to no screening, despite focusing on higher-risk populations with diabetes, according to Jonas, et al. Evidence from nine cohort studies showed that adding resting ECG to traditional risk factors produced small improvements in discrimination and appropriate risk classification for prediction of multiple cardiovascular outcomes, but evidence for this finding was significantly limited by imprecision, quality, considerable heterogeneity and inconsistent use of risk thresholds used for clinical decision making.

In an accompanying JAMA editorial, Robert J. Myerburg, MD, FACC, suggests that moving forward, future research is needed on the topic of resting and exercise ECG markers of risk, for coronary atherosclerosis and other cardiovascular diseases, and for clarification of normal ECG variants in special populations, such as athletes.

In a separate editorial published in JAMA Cardiology, Joseph S. Alpert, MD, FACC, points out that the USPSTF recommendations state that, "the resting or the exercise ECG test is not useful, nor should it be touted, as a screening test for predicting outcomes in asymptomatic individuals without cardiovascular disease."

R. Sacha Bhatia, MD, MBA, and Paul Dorian, MD, MSc, note in a separate editorial comment in JAMA Internal Medicine, that "The USPSTF recommendations are consistent with guidelines from other societies, including the American College of Physicians, the American College of Preventive Medicine, and the American College of Cardiology, all of whom do not recommend ECG screening in patients at low risk for cardiovascular disease. The Choosing Wisely campaign also has recommendations against screening ECGs in asymptomatic patients at low risk for cardiovascular disease."

Clinical Topics: Sports and Exercise Cardiology, Sports and Exercise and ECG and Stress Testing

Keywords: Risk Factors, Athletes, American Medical Association, Exercise Test, Electrocardiography, Coronary Disease, Diabetes Mellitus, Atherosclerosis, Cohort Studies

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