Gerald W. Smetana, MD; Donald E. Cutlip, MD *; Duane S. Pinto, MD, MPH *
Acknowledgment: The authors thank the patient for sharing his story.
Grant Support: Beyond the Guidelines receives no external support.
Disclosures: Dr. Cutlip reports grants from Boston Scientific and Medtronic outside the submitted work. Dr. Pinto reports other support from Medicines Company, Medtronic, Abbott Vascular, and Covidien outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-2910.
Requests for Single Reprints: Gerald W. Smetana, MD, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215; e-mail, gsmetana@bidmc.harvard.edu.
Current Author Addresses: Drs. Smetana, Cutlip, and Pinto: Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215.
In March 2015, the American College of Physicians (ACP) released a clinical guideline on the value of screening for coronary heart disease (CHD) in asymptomatic persons. The guideline authors found that results of screening studies are unlikely to change patient management or the intensity of risk factor reduction strategies. Most events occur in patients who are at low to intermediate risk for CHD; and in low-risk asymptomatic patients, percutaneous coronary intervention in “screen-positive” patients does not improve outcomes and creates unnecessary risks. As a result, the ACP recommended against screening for asymptomatic patients who are at low risk for CHD. Instead, it recommended a focus on proven strategies, such as treatment of hypertension and hypercholesterolemia, to reduce risk in appropriately selected asymptomatic persons. Two discussants weigh the evidence for and against screening for CHD in asymptomatic patients with varying degrees of risk and provide recommendations for a specific patient who is uncertain whether to proceed to screening.
Smetana GW, Cutlip DE, Pinto DS. Should We Screen for Coronary Heart Disease in Asymptomatic Persons?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Ann Intern Med. 2016;164:479–487. doi: 10.7326/M15-2910
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© 2019
Published: Ann Intern Med. 2016;164(7):479-487.
DOI: 10.7326/M15-2910
Cardiology, Coronary Heart Disease, Prevention/Screening.
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