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USPSTF: Evidence insufficient to use ECG for certain CVDs
The USPSTF has issued a draft recommendation that states those with low risk for heart disease or stroke should not be screened with ECG because the harms from testing exceed or equal the benefits.
In a separate draft recommendation, the task force stated that more research is needed to determine if asymptomatic people at increased risk for heart disease or stroke should be screened with ECG, or whether ECG should be used to screen for atrial fibrillation.
“We looked at the latest research on both topics and found that, while the harms of ECGs themselves are minimal, there are larger potential harms from the follow-on procedures, such as an injury due to an exercise ECG (or stress test),” C. Seth Landefeld, MD, task force member and department of medicine chair at the University of Alabama at Birmingham School of Medicine, told Healio Family Medicine. “We also found that more research is needed to determine whether the benefits of screening for [atrial fibrillation] with ECG to prevent strokes outweigh the harms.”
While ECG screening for atrial fibrillation is a new topic for the USPSTF to investigate, the ECG screening for CVD recommendation mirrors the task force’s final recommendation statement from 5 years ago.
“The task force aims to keep all recommendations current and aims to start the review process for each topic every few years,” he explained. “As the task force last reviewed evidence on screening for cardiovascular disease risk with ECG in 2012, it was time for the task force to once again look at the evidence on this important topic.”
Landefeld added, “Regarding the draft recommendation for screening for atrial fibrillation, the task force uses several criteria to decide which new topics to review, including the topic’s relevance to prevention and primary care and the importance for public health. [Atrial fibrillation] affects nearly three million Americans and is a leading cause of stroke. It is the most common problem related to the rhythm of the heart and is more likely to impact older and/or obese people. With an aging society and increased rates of obesity, this was an important topic for the task force to review.”
Landefeld offered suggestions for clinicians who want to implement these draft recommendations in their practices.
“Physicians and their patients should maintain conversations about the patient’s cardiovascular health. Anyone concerned about their risks for a heart attack, stroke, or [atrial fibrillation] should talk to their doctor,” he said. “When considering preventive services, including screening with ECG for intermediate- or high-risk adults of cardiovascular
The task force wrote that the American College of Physicians (ACP) recommends against screening for CVD with resting or stress ECG in asymptomatic, low-risk adults and the AAFP is currently updating its recommendation on this matter. The task force did not indicate if the AAFP or ACP have guidelines regarding screening for atrial fibrillation with ECG.
The USPSTF’s draft recommendation statements can be viewed on the task force’s website: www.uspreventiveservicestaskforce.org. Comments will be accepted until Jan. 22, 2018. – by Janel Miller
Disclosures: Landefeld reports no relevant financial disclosures. Healio Family Medicine was unable to determine the other authors’ relevant financial disclosures prior to publication.