The Role of Resting Electrocardiogram in Screening for Primary Prevention of Cardiovascular Diseases in High-Risk Groups
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NOVEL AND EMERGING RISK FACTORS (K. NASIR, SECTION EDITOR)
The Role of Resting Electrocardiogram in Screening for Primary Prevention of Cardiovascular Diseases in High-Risk Groups Thong Nguyen 1 & George Waits 1 & Elsayed Z. Soliman 2
# Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract Purpose of Review We sought to determine whether a role existed for the screening of certain populations with electrocardiogram (ECG) to improve risk stratification and facilitate risk reduction for primary prevention. Recent Findings Current screening guidelines do not recommend ECG screening for the general population. Summary While current guidelines, based on the available evidence, do not recommend ECG screening for the general population, in this report, we show that certain groups such as the elderly, those with hypertension, diabetes, or chronic kidney disease, may benefit from screening as a cost-effective means for identifying those at risk for future cardiovascular disease events. However, future studies are needed to standardize ECG markers and further qualify the screening value in these populations. Keywords Resting ECG . Cardiac screening . Primary prevention
Introduction Primary prevention, as defined by the World Health Organization (WHO), is the “actions aimed at avoiding the manifestation of a disease.” [1] The United States Preventative Services Task Force (USPSTF) evaluates all the available evidence about a particular screening test to determine benefits and harms. If the net benefit is such that implementation would improve health outcomes in a general primary care population, then the screening test is awarded a favorable letter grade [2]. The Cleveland Clinic further expands on the ideal screening test to include criteria such as cost efficiency, non-invasiveness, and the manifestations of the disease if left untreated [3].
This article is part of the Topical Collection on Novel and Emerging Risk Factors * George Waits [email protected] 1
Department of Internal Medicine, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA
2
Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC, USA
One screening test that has yet to show efficacy in the general population is the evaluation of the future risk of coronary artery disease (CAD) with an electrocardiogram (ECG). Both the USPSTF and the American College of Physicians (ACP) have concluded against a screening ECG in asymptomatic adults that are of low risk for CAD, as the cost and harm of further downstream testing outweigh the mild benefits [4, 5]. On the other hand, the USPSTF determined that the evidence was inconclusive in screening asymptomatic adults who were at moderate to high risk for coronary disease. This was primarily based on the lack of available data to accurately reclassify a patient from their current risk group (i.e., low, moderate, high) to a higher or lower group, leaving clinicians with
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