Cardiac screening in asymptomatic, low-risk adults has not been shown to improve patient outcomes and is associated with potential harms due to false-positive results.
Does cardiac screening with resting or stress ECG, stress echocardiography, or myocardial perfusion imaging improve outcomes in asymptomatic, low-risk adults?
The American College of Physicians advises against cardiac screening with ECG or imaging in asymptomatic, low-risk adults due to lack of benefit and potential for harm.
BACKGROUND: Cardiac screening in adults with resting or stress electrocardiography, stress echocardiography, or myocardial perfusion imaging can reveal findings associated with increased risk for coronary heart disease events, but inappropriate cardiac testing of low-risk adults has been identified as an important area of overuse by several professional societies. METHODS: Narrative review based on published systematic reviews; guidelines; and articles on the yield, benefits, and harms of cardiac screening in low-risk adults. RESULTS: Cardiac screening has not been shown to improve patient outcomes. It is also associated with potential harms due to false-positive results because they can lead to subsequent, potentially unnecessary tests and procedures. Cardiac screening is likely to be particularly inefficient in adults at low risk for coronary heart disease given the low prevalence and predictive values of testing in this population and the low likelihood that positive findings will affect treatment decisions. In this patient population, clinicians should focus on strategies for mitigating cardiovascular risk by treating modifiable risk factors (such as smoking, diabetes, hypertension, hyperlipidemia, and overweight) and encouraging healthy levels of exercise. HIGH-VALUE CARE ADVICE: Clinicians should not screen for cardiac disease in asymptomatic, low-risk adults with resting or stress electrocardiography, stress echocardiography, or stress myocardial perfusion imaging.
Roger Chou (2015) conducted a review in Asymptomatic, low-risk adults. Cardiac screening (resting or stress ECG, stress echocardiography, or myocardial perfusion imaging) was evaluated on Patient outcomes. Cardiac screening in asymptomatic, low-risk adults has not been shown to improve patient outcomes and is associated with potential harms due to false-positive results.