ACC issues statement on Public Citizen's criticism of broad cardiac screenings

Patrick T. O’Gara, MD, president of the American College of Cardiology, has issued a statement in response to consumer group Public Citizen’s criticism of widely promoted cardiac screenings, saying the group’s concerns have “some merit.”

“The American College of Cardiology and American Heart Association have joint guidelines that offer recommendations to guide physicians in making decisions with individual patients about their risk for heart attack and stroke,” O’Gara said in a press release. “Other than assessing blood pressure and serum cholesterol, being attentive to diabetes and promoting a healthy weight with regular exercise, we do not recommend broad and untargeted screening. Decisions about the need for additional testing should be based on each patient’s circumstances.”

Public Citizen has called upon 20 hospitals in eight states to discontinue their partnerships with Winter Park, Florida-based HealthFair Health Screening. HealthFair promotes low-cost CVD screening packages to residents living in proximity to the partnering hospitals and institutions. These packages are offered without consideration of screening appropriateness according to individual risk factors, Public Citizen said in a separate press release.

HealthFair’s basic CV screening packages consist of six tests that image the heart, evaluate its electrical activity and test for arterial blockages. These tests are conducted in buses that travel within the regions surrounding the partner hospitals and medical institutions.

The screening packages are promoted through direct-to-consumer advertising, either online through HealthFair’s or the partnering hospital’s websites, or through solicitation letters mailed directly to residents’ homes.

According to Public Citizen, the promotions falsely indicate that, for most adults, the screening packages are beneficial for preventing events such as MI, stroke and ruptured abdominal aortic aneurysm.

Public Citizen maintains that such non-selective testing often leads to false-positive results, or may reveal minor abnormalities that would never have caused symptoms or events. In both cases, patients may become worried unnecessarily or proceed to undergo risky tests without cause. Moreover, such downstream testing represents an added cost for patients and insurance companies.

According to Public Citizen, such broadly promoted screenings are not advocated by medical experts because the tests are only beneficial for specific, high-risk patients or provide no clinically meaningful benefits at all.

“It is exploitative to promote and provide medically non-beneficial testing through the use of misleading and fear-mongering advertisements in order to generate medically unnecessary but profitable referrals to the institutions partnered with HealthFair,” Michael Carome, MD, director of Public Citizen’s Health Research Group, said in a press release. “Consumers are being misled to believe that these screening packages are beneficial, when in reality many will undergo additional unnecessary testing, likely putting them at greater risk, not saving them any money and adding unneeded anxiety.”

According to O’Gara, the ACC has taken steps toward increased scrutiny of overused or unnecessary testing.

“The American College of Cardiology participates in the Choosing Wisely campaign, which encourages physicians and patients to discuss the costs and benefits of often overused tests and procedures,” he said.