Why Some Patients May Not Need Heart Screening

Heart disease screening may not be necessary in low-risk patients

(RxWiki News) If you're worried about heart disease, at least you might be able to skip the fancy screening. Using high-tech diagnostic procedures for heart disease screening may be unnecessary for many patients.

A new paper published by the American College of Physicians (ACP) said the risks may not be worth the potential harms. Also, screening using tests like resting or stress electrocardiograms, stress echocardiograms or stress myocardial perfusion testing has not been found to reduce the risk of death from heart disease.

The ACP noted that other, less expensive diagnostic tests can provide adequate information to guide most treatment.

Dr. David Fleming, the current president of the ACP, noted in a press release, "Cardiac screening in adults at low risk for coronary heart disease is low value care because it does not improve patient outcomes and it can lead to potential harms. Physicians should instead focus on strategies for improving cardiovascular health by treating modifiable risk factors such as smoking, diabetes, hypertension, high cholesterol, obesity, and encouraging healthy levels of exercise."

Dr. Fleming added, “It is easy to overlook false positives as potential harms, for example, but they may result in unnecessary tests and treatments with their own additional risks, and the harms of radiation exposure may not be seen for years."

Dr. Roger Chou, an internist from Oregon Health and Science University, was the lead author of the ACP paper.

The ACP has a High Value Care Task Force composed of experts in a variety of medical fields. The task force studies scientific literature and periodically issues guidelines to direct patient care.

The focus of the task force is to identify diagnostic or treatment options that improve health, avoid harm, and decrease or eliminate waste. High Value Care, as defined by the ACP, includes services that provide sufficient benefit to make their harms and costs worthwhile.

Heart disease is the leading cause of death in the US, according to Dr. Chou and colleagues. Diagnostic tests, they note, may be useful to determine how bad a problem is once the patient begins to display symptoms.

However, using those same tests to screen for heart disease is overdoing it, Dr. Chou and team said. For instance, an electrocardiogram, or EKG, is often obtained as a “baseline” test during cardiac screening.

The ACP guideline now says this test is unnecessary, as are several other tests that use X-rays or other forms of radiation. Radiation can increase cancer risk.

Dr. Chou and colleagues said doctors should use a global risk score to assess patient’s risk of heart disease. The global risk score would look at many factors, such as smoking, age, blood pressure and cholesterol.

The lower the global risk score, the less likely that high-tech screening will benefit the patient. Patients with a low risk score who have symptoms of heart disease like chest pain should have the diagnostic tests, according to the task force.

The ACP task force said doctors can provide a higher value service by using lab tests to screen for cholesterol or diabetes and taking a thorough patient history. Patients who have risk factors like smoking or high blood pressure should be counseled or treated, according to the ACP.

The new ACP guideline was published March 16 in the Annals of Internal Medicine.

The ACP funded the research. Dr. Chou received grants from the American College of Physicians during the study and grants from the Agency for Healthcare Research and Quality outside the submitted work. Dr. Moyer was chair of the American College of Physicians Board of Governors for 2014–2015. Dr. Skeff consulted for Wolters Kluwer Health outside the submitted work.

Review Date: 
March 16, 2015