Screening for CVD Risk With ECG: USPSTF Recommendation

Study Questions:

What is the US Preventive Services Task Force (USPSTF) recommendation on screening for coronary heart disease with electrocardiography (ECG) or exercise ECG in this 2012 update?

Methods:

The USPSTF reviewed the evidence on whether screening with resting or exercise ECG improves health outcomes compared with the use of traditional cardiovascular disease (CVD) risk assessment alone in asymptomatic adults.

Results:

For asymptomatic adults at low risk of CVD events (individuals with a 10-year CVD event risk <10%), it is very unlikely that the information from resting or exercise ECG (beyond that obtained with conventional CVD risk factors) will result in a change in the patient’s risk category, as assessed by the Framingham Risk Score or Pooled Cohort Equations, that would lead to a change in treatment and ultimately improve health outcomes. Possible harms are associated with screening with resting or exercise ECG, specifically the potential adverse effects of subsequent invasive testing. For asymptomatic adults at intermediate or high risk of CVD events, there is insufficient evidence to determine the extent to which information from resting or exercise ECG adds to current CVD risk assessment models, and whether information from the ECG results in a change in risk management and ultimately reduces CVD events. As with low-risk adults, possible harms are associated with screening with resting or exercise ECG in asymptomatic adults at intermediate or high risk of CVD events.

Conclusions:

The USPSTF recommended against screening with resting or exercise ECG to prevent CVD events in asymptomatic adults at low risk of CVD events (D recommendation). The USPSTF concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening with resting or exercise ECG to prevent CVD events in asymptomatic adults at intermediate or high risk of CVD events (I statement).

Perspective:

Many clinicians will argue the value of obtaining an ECG in adults to establish a baseline for future reference. This is not the subject of the review. Of course there have been no studies designed specifically to evaluate whether screening with an ECG in asymptomatic persons can reduce or prevent CVD events. However, an ECG would be indicated despite the absence of symptoms in persons with hypertension, a murmur, gallop, or arrhythmia on cardiac exam, and in persons with a family history of hypertrophic or other cardiomyopathy and sudden death. A caveat recognized by the Task Force is that for persons in certain occupations, such as pilots and operators of heavy equipment, for whom sudden incapacitation or death may endanger the safety of others, this may influence the decision to screen with ECG to prevent CVD events. It does not support a stress ECG, however. The American College of Cardiology has a Class II, Level of Evidence B recommendation for stress ECG in asymptomatic persons for the following: 1) evaluation of persons with multiple risk factors, and 2) evaluation of asymptomatic men >40 years and women >50 years who plan to start vigorous exercise (especially if sedentary), or who are involved in occupations in which impairment might impact public safety, or who are at high risk for coronary artery disease due to other diseases (e.g., chronic renal failure).

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Hypertension

Keywords: Arrhythmias, Cardiac, Cardiomyopathies, Cardiovascular Diseases, Coronary Disease, Death, Sudden, Electrocardiography, Exercise Test, Hypertension, Outcome Assessment (Health Care), Primary Prevention, Risk Assessment, Risk Factors


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