Paul Zimmermann, MD
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOf InterestForms.do?msNum=L15-0260.
Zimmermann P. Cardiac Screening. Ann Intern Med. 2015;163:151. doi: 10.7326/L15-5112
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Published: Ann Intern Med. 2015;163(2):151.
TO THE EDITOR:
Chou's guideline (1) on cardiac screening recommends that asymptomatic adults not have resting electrocardiography (ECG). I find that this recommendation, in many instances, goes against the standard of care. Obtaining ECGs for screening is standard for athletes, who, by definition, are asymptomatic. The European Community (2) continues to find this intervention cost-effective.
To argue against screening ECGs, Chou cites 2 articles showing their limited usefulness. Rubenstein and Greenfield (3) found that "the routine ECG has little value as a baseline." However, they state that 5% of patients were grouped into a class in which ECGs could be useful. A total of 5% of patients seems pretty important to me. Hoffman and Igarashi (4) recommend against routinely ordering ECGs in patients with chest pain. This conclusion today is consistent with medical malpractice.
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