ACP says no to screening adults with low risk of heart disease

 - thumbs down, reject

Adults who are at low risk for coronary heart disease shouldn’t undergo screening with resting or stress electrocardiography, stress echocardiography, or stress myocardial perfusion imaging, according to an article published in the Annals of Internal Medicine by the American College of Physicians (ACP).

“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,” said ACP President David Fleming, MD, in a release. “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.”

In the article, Roger Chou, MD, on behalf of the High Value Care Task Force of the American College of Physicians, wrote that there is little evidence that cardiac screening improves outcomes. It is also associated with potential harm due to false positives, he wrote, that can lead to potentially unnecessary tests and procedures.

He also pointed out myocardial perfusion imaging results in radiation exposure from the use of radionuclide tracers.

Chou wrote that despite the fact that there is little evidence that screening this population has any benefits, and carries potential harms, cardiac screening tests are frequently—and perhaps increasingly—carried out in clinical practice.

Why? Chou suggested inappropriate cardiac screening is being driven by patient expectations, commercial screening programs, financial incentives, defensive medicine and overestimating both the harms and benefits of screening.

“Implementing recommendations that focus on initial cardiovascular risk assessment based on traditional cardiovascular risk factors and using a global risk score, addressing modifiable risk factors, and not performing additional cardiac screening in low-risk patients would improve patient care while avoiding unnecessary harms and costs,” Chou wrote. “To be most effective, efforts to reduce the use of imaging should be multifocal and should address clinician behaviors, patient expectations, direct-to-consumer screening programs, and financial incentives.”