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Screening for Coronary Heart Disease With Electrocardiography: U.S. Preventive Services Task Force Recommendation Statement FREE

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The full report is titled “Screening for Coronary Heart Disease With Electrocardiography: U.S. Preventive Services Task Force Recommendation Statement.” It is in the 2 October 2012 issue of Annals of Internal Medicine (volume 157, pages 512-518). The author is Virginia A. Moyer, MD, MPH, on behalf of the U.S. Preventive Services Task Force.


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Ann Intern Med. 2012;157(7):I-38. doi:10.7326/0003-4819-157-7-201210020-00520
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Who developed these guidelines?

The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that reviews published research and makes recommendations about preventive health care.

What is the problem and what is known about it so far?

Coronary heart disease (CHD) is the result of blockages in the heart's blood vessels. Low blood flow to the heart due to blocked vessels can cause chest pain (angina). If the blockage lasts long enough, a section of heart muscle dies, a condition called myocardial infarction (a “heart attack”). Although many people with CHD have symptoms, including chest pain or shortness of breath, others have no symptoms at first and may not know that they have CHD until a heart attack occurs. Risk factors for CHD include older age, male sex, high blood pressure, diabetes, smoking, high levels of total or low-density lipoprotein (“bad”) cholesterol and low levels of high-density lipoprotein (“good”) cholesterol, and a family history of CHD. A patient's risk for heart attacks or angina can be estimated on the basis of risk factors. Treatments are available to reduce risk for CHD events in some patients at increased risk, such as those with high cholesterol or high blood pressure.

Electrocardiography (ECG) is a test that examines the heart's electrical activity either at rest (resting ECG) or during exercise (exercise ECG). Doctors should look for CHD with ECG when patients have symptoms that might be due to the disease. With respect to using ECG to look for CHD in patients with no symptoms, the USPSTF recommended in 2004 against routine screening with resting or exercise ECG in adults at low risk for CHD events. It is uncertain whether doctors should also screen patients with no symptoms for CHD if they are at increased risk because of certain risk factors. The USPSTF wanted to update the recommendations by considering new studies since 2004.

How did the USPSTF develop these recommendations?

The USPSTF reviewed research about the benefits and harms of using resting or exercise ECG to look for CHD in patients without symptoms. Potential benefits would be decreased angina, heart attacks, disability, and premature death. Potential harms would be unnecessary testing, treatment, and labeling related to false-positive results. False-positive results suggest CHD in patients who do not have the disease and can lead to harm from unnecessary follow-up testing and treatment.

What did the authors find?

For patients at low risk for CHD, adequate evidence shows that the additional information that resting or exercise ECG offers beyond that obtained by measuring traditional risk factors is highly unlikely to ultimately reduce CHD events. For patients at medium or high risk for CHD, there is not enough information to know whether screening reduces CHD events.

What does the USPSTF recommend that patients and doctors do?

Patients at low risk for CHD should not be screened with resting or exercise ECG.

It is uncertain whether patients at medium to high risk for CHD will benefit from screening with resting or exercise ECG.

What are the cautions related to these recommendations?

These recommendations apply only to patients with no symptoms and may change as new studies become available.

This article was published at www.annals.org on 31 July 2012.

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