Screening for Cardiovascular Disease Risk With Electrocardiography: US Preventive Services Task Force Recommendation
, Susan J Curry1, Alex H Krist2,3
1University of Iowa, Iowa City.
Insights
Screening asymptomatic adults with electrocardiography (ECG) for cardiovascular disease (CVD) is not recommended for low-risk individuals. Evidence is insufficient for intermediate or high-risk adults, with potential harms outweighing benefits.
Area of Science:
- Cardiovascular Medicine
- Preventive Cardiology
- Diagnostic Testing
Background:
- Cardiovascular disease (CVD) is a leading cause of death in the US, with risk assessment tools like Framingham Risk Score guiding preventive strategies.
- Current guidelines for CVD prevention rely on risk stratification to inform treatment decisions for asymptomatic adults.
Purpose of the Study:
- To update the US Preventive Services Task Force (USPSTF) recommendation on screening for coronary heart disease using electrocardiography (ECG).
- To evaluate the effectiveness of ECG screening compared to traditional risk assessment in asymptomatic adults.
Main Methods:
- Systematic review of evidence on resting or exercise ECG screening in asymptomatic adults.
- Comparison of health outcomes between ECG screening and conventional CVD risk assessment alone.
Main Results:
- For low-risk asymptomatic adults, ECG screening offers minimal benefit beyond existing risk assessment and carries potential harms from subsequent invasive procedures.
- For intermediate and high-risk asymptomatic adults, evidence is insufficient to determine if ECG screening improves risk management or reduces CVD events.
Conclusions:
- The USPSTF recommends against ECG screening for low-risk asymptomatic adults due to unlikely benefits and potential harms.
- The USPSTF found insufficient evidence to assess the benefits and harms of ECG screening for intermediate or high-risk asymptomatic adults.
Importance:
Cardiovascular disease (CVD), which encompasses atherosclerotic conditions such as coronary heart disease, cerebrovascular disease, and peripheral arterial disease, is the most common cause of death among adults in the United States. Treatment to prevent CVD events by modifying risk factors is currently informed by CVD risk assessment with tools such as the Framingham Risk Score or the Pooled Cohort Equations, which stratify individual risk to inform treatment decisions.
Objective:
To update the 2012 US Preventive Services Task Force (USPSTF) recommendation on screening for coronary heart disease with electrocardiography (ECG).
Evidence Review:
The USPSTF reviewed the evidence on whether screening with resting or exercise ECG improves health outcomes compared with the use of traditional CVD risk assessment alone in asymptomatic adults.
Findings:
For asymptomatic adults at low risk of CVD events (individuals with a 10-year CVD event risk less than 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 And Recommendation:
The USPSTF recommends against screening with resting or exercise ECG to prevent CVD events in asymptomatic adults at low risk of CVD events. (D recommendation) The USPSTF concludes 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).
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