- A federal task force is urging doctors not to perform electrocardiograms on patients with low risk of heart disease.
- While EKGs are safe and relatively inexpensive, there is insufficient evidence to show that the benefits outweigh the risks, which include possible harms from subsequent, more invasive testing, the U.S. Preventive Services Task Force writes.
- “If existing CVD [cardiovascular disease] risk assessment tools could be improved, treatment might be better targeted, thereby maximizing the benefits of and minimizing the harms of screenings,” the task force wrote in a statement published Tuesday in JAMA.
The recommendation comes as healthcare organizations are looking for ways to cut down on unnecessary or inappropriate care. A survey last year of 2,106 U.S. doctors found that, on average, they believe 20.6% of medical care is unnecessary, including 24.9% of tests and 11.1% of procedures. The overriding reason was fear of malpractice (85%), but patient pressure and difficulty accessing medical records were also frequently cited.
Some experts have estimated the U.S. wastes upwards of $200 billion annually on excess medical tests and treatments — contributing to about 30,000 deaths due to errors and injuries.
Resting and exercise EKGs are used to evaluate people suspected of CVD, leading to suggestions that the device may be useful in asymptomatic patients as well. Those who receive an abnormal EKG result are often referred for further testing and treatment, ranging from invasive studies to imaging scans and medication.
In two studies of asymptomatic adult diabetics, 6% and 12% of those screened while exercising subsequently underwent angiography and 3% and 5% of participants underwent vascular re-routing in the heart or extremities, without evidence that the procedures improved their health, USPSTF wrote.
The USPSTF reviewed 14 cohort studies assessing whether adding either an exercise EKG or resting EKG to existing CVD risk assessment models enhanced calibration, discrimination or reclassification of a patient’s risk. None of the resting EKG studies looked at outcomes, and the two exercise EKG studies that did had too few participants to provide a meaningful result.
“For asymptomatic adults at low risk of CVD events (individuals with a 10-year CVD event risk less than 10%), it is very unlikely that the information from resting or exercise EKG (beyond that obtained with conventional CVD risk factors) will result in a change in the patient’s risk category as assessed ... that would lead to a change in treatment and ultimately improved health outcomes,” the statement concluded.
The Choosing Wisely campaign, which promotes discussion about questionable tests and procedures, also recommends against screening EKGs in asymptomatic patients at low risk for heart disease.