ECGs in Low-Risk Patient Annual Health Exam

Study Questions:

What is the frequency of electrocardiograms (ECGs) following an annual health examination (AHE) with a primary care physician among patients with no known cardiac conditions or risk factors, and how does downstream cardiac testing and clinical outcomes vary between patients who did and did not receive an ECG?


This was a population-based retrospective cohort study using administrative health care databases from Ontario, Canada.


A total of 3,629,859 adult patients had at least one AHE. Of these patients, 21.5% had an ECG within 30 days after an AHE. The proportion of patients receiving an ECG after an AHE varied from 1.8% to 76.1% among 679 primary care practices and from 1.1% to 94.9% among 8,036 primary care physicians. Patients who had an ECG were significantly more likely to receive additional cardiac tests, visits, or procedures than those who did not (odds ratio [OR], 5.14; p < 0.001). The rates of death (0.19% vs. 0.16%), cardiac-related hospitalizations (0.46% vs. 0.12%), and coronary revascularizations (0.20% vs. 0.04%) were low in both the ECG and non-ECG cohorts.


ECG testing after an AHE is common, and varies significantly among primary care physicians. Routine ECG testing increases risk for a subsequent cardiology testing and consultation, despite the overall cardiac event rate being very low.


The United States Preventive Services Task Force and many medical societies recommend against routine ECG testing among low-risk patients presenting for a periodic health evaluation. Nonetheless, the practice is common, and leads to additional cardiac testing and consultation. There is significant practice variation among regions, practices, and individual physicians. According to this study, some physicians were almost 90 times more likely to order an ECG than some of their colleagues. This study does not necessarily prove that an inappropriately ordered ECG results in inappropriate additional testing and consultations. It is possible that physicians already may have the intent to refer patients, and the ECG is the first apparent prerequisite.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias

Keywords: Arrhythmias, Cardiac, Diagnostic Tests, Routine, Electrocardiography, Myocardial Revascularization, Outcome Assessment (Health Care), Physicians, Primary Care, Primary Health Care, Primary Prevention, Risk Factors

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