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Screening for coronary artery disease in assymptomatic adults is not recommended, so why is it still done?
1Centro de Estudos de Medicina Baseada na Evidência Faculdade de Medicina de Lisboa, Lisboa, Portugal. avc@fm.ul.pt
Insights
Screening for asymptomatic coronary artery disease in low-risk individuals is not recommended. Current evidence indicates these tests cause more harm than good due to false positives and overdiagnosis.
Area of Science:
- Cardiology
- Preventive Medicine
- Diagnostic Testing
Background:
- Asymptomatic coronary artery disease (CAD) screening aims to detect advanced disease and prevent sudden death.
- Early detection could enable risk factor intervention and preventive revascularization.
Purpose of the Study:
- To evaluate the benefit-harm ratio of screening for asymptomatic coronary artery disease in low-risk patients.
- To provide recommendations on current screening practices for coronary heart disease.
Main Methods:
- Review of recent evidence on screening for coronary artery disease using resting electrocardiogram, exercise tolerance testing, and electron-beam computerized tomography.
- Analysis of the benefit-harm ratio, considering false-positive rates and subsequent diagnostic cascades.
Main Results:
- Screening for coronary artery disease in low-risk patients yields a negative benefit-harm ratio.
- High false-positive rates lead to unnecessary further testing, overdiagnosis, and negative psychological and financial consequences.
- The harms associated with screening outweigh the benefits of detecting actual disease.
Conclusions:
- Screening for asymptomatic coronary artery disease in low-risk individuals should not be performed.
- The Portuguese Society of Cardiology should advise against current screening practices for asymptomatic coronary heart disease.
- Abandoning these screening methods is recommended due to their limited utility and overall harmfulness.
Abstract:
The rationale behind screening for asymptomatic coronary artery disease is that it may diagnose advanced disease that, while frequently without symptoms, may present for the first time as sudden death. Identifying significant coronary artery disease would enable intervention against risk factors and, if necessary, preventive revascularization. The most recent evidence shows that screening for coronary artery disease with resting electrocardiogram, exercise tolerance testing or electron-beam computerized tomography in low-risk patients does more harm than good, and should not be performed. This negative recommendation is based on the fact that the use of the aforementioned tests has a negative benefit-harm ratio, because the false-positive rate cancels out any benefit from the occasional detection of real disease, inducing a cascade of further testing (sometimes with angiography) and overdiagnosis of a disease that is not in fact present, with negative psychological and financial consequences, such as increased insurance premiums. We feel that the Portuguese Society of Cardiology should intervene with the institutions performing screening of coronary heart disease in asymptomatic patients, and recommend abandoning a practice that is of little use and, overall, harmful.
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