USPSTF Does Not Recommend ECG Screening in Low-Risk CVD

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This USPSTF recommendation on ECG screening for CVD events is an update of a 2012 recommendation, which advised against screening in adults with low risk for CHD.
This USPSTF recommendation on ECG screening for CVD events is an update of a 2012 recommendation, which advised against screening in adults with low risk for CHD.

In asymptomatic adults at low risk for cardiovascular disease (CVD) events, the US Preventive Services Task Force (USPSTF) does not recommend screening with resting or exercise electrocardiography (ECG), according to a USPSTF statement published in the Journal of the American Medical Association.

The USPSTF stated that is “very unlikely” that information obtained from an ECG screening would result in a change in risk category as assessed by the Framingham Risk Score or Pooled Cohort Equations in adults with a low risk for CVD events (a 10-year CVD event risk <10%) that would lead to treatment changes or improvements in health outcomes.

The USPSTF also noted several potential harms that could result from unnecessary screening across all risk categories, such as radiation exposure from invasive confirmatory testing, angiography, and revascularization. The latter 2 procedures are associated with bleeding, contrast-induced nephropathy, allergic reaction to the contrast agent, cardiac arrhythmia, stroke, myocardial infarction, coronary artery dissection, and death.

This recommendation is an update of the USPSTF's 2012 recommendation statement, which advocated against ECG screening in adults with a low risk for coronary heart disease (D recommendation). A lack of evidence for recommending screening in intermediate- or high-risk adults was also noted at that time (I statement).

In the current recommendation, the same USPSTF grades have been issued for ECG screening to prevent CVD events.

“If existing CVD risk assessment tools could be improved, treatment might be better targeted, thereby maximizing the benefits of and minimizing the harms of screening,” the Task Force concluded.

For other methods of CVD prevention, the USPSTF points to high blood pressure screening, smoking cessation counseling, and diet/exercise intervention, as well as low-dose aspirin in certain individuals at an increased risk for CVD events.

Reference

US Preventive Services Task Force. Screening for cardiovascular disease risk with electrocardiography. US Preventive Services Task Force Recommendation. JAMA. 2018;319(22):2308-2314. doi:10.1001/jama.2018.6848

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