Don't Use Screening ECG to Predict Coronary Events in Low-Risk Adults, Say AAFP, USPSTF

The AFFP has reaffirmed its position against "screening with resting or exercise electrocardiography (ECG) for the prediction of coronary heart disease (CHD) events in asymptomatic adults at low risk for CHD." The AAFP position aligns with that issued this week by the U.S. Preventive Services Task Force (USPSTF).

Family physician and USPSTF member Joy Melnikow, M.D., M.P.H., of Sacramento, Calif., told AAFP News Now the task force made a D recommendation after it concluded that, as was the case with the previous recommendation issued in 2004, the current evidence indicates that "the potential harms of screening for CHD with exercise or resting ECG equal or exceed the potential benefits in this population."

"Overall, I think there are three important things to understand here," Melnikow said. "First, this recommendation applies to asymptomatic adults. Second, it applies to those considered to be at low risk for CHD, as screening may not offer any additional information and may, in fact, increase the likelihood of harming the patient.

"Those harms that we reference are not direct results of the screening, but may come as a result of a false-positive test leading to further testing, like cardiac catheterization."

Third, according to Melnikow, for individuals whose conventional risk factor score puts them in the intermediate- to high-risk category, current information still is insufficient to determine whether a resting or exercise ECG would offer enough additional information to help physicians better manage their condition.

Melnikow said it is not unusual for her patients to ask for this type of screening, but she will continue to encourage them to instead seek alternative ways to measure -- and then work to reduce -- their risk for CHD events.

"I focus on the risk factors associated with CHD and what we can do to manage and reduce any of those risk factors that the patient may have, such as smoking, hypertension and hyperlipidemia," she said.

"When I talk to my patients about what we, as doctors, know about the evidence surrounding this type of screening and that it may not be helpful, the response is always good. As family physicians, the whole conversation is easier, because we have a relationship with our patients, and they trust us."