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USPSTF recommends against electrocardiography screening in low-risk adults

Clinical Question:
What are the recommendations from the United States Preventive Services Task Force regarding the use of electrocardiography to screen for heart disease in low- and high-risk patients?

Bottom Line:
Reiterating their 2004 statement, the United States Preventive Services Task Force (USPSTF) recommends against routine screening of asymptomatic patients with electrocardiography (ECG). They also continue to report insufficient evidence to determine whether ECG testing adds any information to risk assessments in patients at intermediate or high risk of coronary heart disease (CHD). (LOE = 5)

Reference:
Moyer VA, on behalf of the U.S. Preventive Services Task Force. Screening for coronary heart disease with electrocardiography: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2012;157(7):512-518.  [PMID:22847227]

Study Design:
Practice guideline

Funding:
Government

Setting:
Outpatient (any)

Synopsis:
Citing evidence that suggests with moderate certainty that the potential harms of screening for CHD outweigh the benefits in patients at low risk for CHD, the USPSTF discourages the use of routine screening with either resting ECG or exercise ECG in this group (D recommendation). The potential harms include the risks associated with additional invasive confirmatory testing (eg, angiography) and with procedures such as revascularization that have not been shown to reduce CHD events in asymptomatic patients. Other harms include the labeling of the patient and the adverse effects of that label on the patient's quality of life. The task force also concludes that there is insufficient evidence to determine whether ECG testing is helpful in intermediate-risk or high-risk patients without symptoms (I statement). They were unable to identify evidence that shows that ECG adds anything to risk determination methods, such as risk calculators, that would improve outcomes in these patients.

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