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

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.

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.

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.

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.

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.

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.