USPSTF updates guidance on screening electrocardiography

The U.S. Preventive Services Task Force (USPSTF) recently updated its recommendations on screening for coronary heart disease (CHD) using electrocardiography (ECG).

According to the current recommendations, asymptomatic adults at low risk for CHD events should not be screened with resting or exercise ECG. For asymptomatic patients at intermediate or high risk, the evidence is insufficient to balance benefits and harms of ECG screening, the USPSTF found. The recommendations were published in Annals of Internal Medicine on July 31.

The recommendations are an update of the task force's 2004 recommendations, which came to the same conclusions. The task force said that for low-risk patients, ECG screening is unlikely to provide additional information beyond that available from conventional risk assessment methods, such as the Framingham ATP III calculator. Higher-risk patients should receive risk factor modification, regardless of ECG findings. Potential harms from screening include unnecessary invasive procedures, overtreatment and labeling.

The recommendation not to screen low-risk patients was a D recommendation, made with moderate certainty. No organizations currently recommend ECG screening for low-risk patients, but “anecdotally, it is performed with some frequency,” the task force noted.

ACP has recommended against the use of both resting and exercise ECG screening for patients at low risk for CHD as part of the College's High Value Cost-Conscious Care Initiative, and against the use of exercise ECG screening for patients at low risk for CHD in its contribution to the ABIM Foundation's Choosing Wisely campaign. Both of these efforts are focused on fostering the appropriate use of clinical tests to improve patient care while reducing the potential risks and costs associated with low-yield interventions.