Clinicians should not use resting or stress electrocardiography, stress echocardiography, or stress myocardial perfusion imaging to screen asymptomatic, low-risk adults for cardiac disease, advised the American College of Physicians (ACP) in guidelines published March 17 in the Annals of Internal Medicine. 


On behalf of the High Value Care Task Force of the ACP, Roger Chou, MD, reviewed the literature on the benefits and risks of cardiac screening, finding that cardiac screening did not improve outcomes in low-risk adults and is also associated with potential harm due to false-positive results, as these lead to more unnecessary tests and procedures.

With low-risk patients, these tests were particularly inefficient, given low prevalence and predictive values and the low likelihood that positive results will affect treatment. 


“Cardiovascular risk assessment should start with a global risk score that combines individual risk factor measurements into a single quantitative estimate of risk,” Dr. Chou wrote.

“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.”