ACP says no to heart screening for low-risk adults

ACP recommends no heart screening for low-risk adults

Adults at low risk of developing heart disease do not benefit from heart screening with electrocardiography, stress electrocardiography, or myocardial perfusion imaging (MPI), according to a new article from the American College of Physicians (ACP).

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The ACP reached its conclusion based on a systematic review and recommendations from the U. S. Preventive Services Task Force (USPSTF), guidelines and standards developed by the American College of Cardiology in conjunction with other professional societies, and articles on the yield, benefits, and harms of cardiac screening.

The authors stated that the article is not a formal systematic review, but instead seeks to provide doctors with practical advice based on the best available evidence on cardiac screening.

"Cardiac screening is likely to be particularly inefficient in adults at low risk for coronary heart disease (CHD) given the low prevalence and predictive values of testing in this population and the low likelihood that positive findings will affect treatment decisions," wrote Roger Chou, MD, and colleagues from the ACP's High Value Task Force.

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The authors instead recommend that clinicians focus on strategies to lessen cardiovascular risk by treating modifiable risk factors such as hypertension and smoking, and encouraging healthy levels of exercise.

The authors wrote that cardiac screening has not been linked to improved patient outcomes, and that over 90 percent of low-risk adults will not have a cardiac event within the next 10 years and cannot benefit from additional screening over that period. They also cited radiation exposure, which has been associated with an increased risk of cancer, as a potential harm of MPI screening.

The study was published in the Annals of Internal Medicine on March 17.

Cardiovascular disease results in 1 in 3 deaths in the United States, approximately 800,000 deaths a year.

Although a recent study conducted by Scottish researchers found that CT scans may help doctors diagnose heart problems in patients with chest pain better than standard tests -- such as the EKG and stress tests that the ACP is now recommending against -- a separate federal study found that people checked with a CT scan after seeing a doctor for chest pain had no less risk of heart attack or dying than those who take a stress or treadmill test.

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