Clinical Question

Does screening for heart disease with echocardiography decrease mortality, myocardial infarction risk, or stroke risk?

Bottom Line

Population-based screening for heart disease or valve disease with echocardiography will identify cardiac pathology in patients but does not decrease mortality, myocardial infarction risk, or stroke risk. (Level of Evidence = 1b)

Synopsis

In 1994 and 1995, researchers enrolled 6,861 middle-aged (average age = 60 years) inhabitants of a single city (Tromsø, Norway). The participants were randomly assigned, concealed allocation unknown, to a onetime screening for heart disease using two-dimensional echocardiography or to no screening. Participants in both groups were white and evenly split by sex. Approximately 12% of patients self-reported coronary heart disease, 59% had hypertension (although only 13.5% were treated with medication), 32% smoked, and only 4% had diabetes mellitus. Screening identified 7.6% of patients with cardiac or valvular conditions, who were then treated. Over 15 years of follow-up, 26.9% of the participants in the screening group died, compared with 27.6% in the control group (not significant). Similarly, there was no effect of screening on rates of sudden death, mortality from heart disease, or incidence of fatal or nonfatal myocardial infarction and stroke.

Study design: Randomized controlled trial (nonblinded)

Funding source: Unknown/not stated

Allocation: Uncertain

Setting: Population-based

Referecne: LindekleivHLøchenMLMathiesenEBNjølstadIWilsgaardTSchirmerHEchocardiographic screening of the general population and long-term survival: a randomized clinical study. JAMA Intern Med. 2013; 173( 17): 1592– 1598.