Should an EKG (electrocardiogram) be a ROUTINE part of Health Maintenance Exams?
We have been writing about the ABIM Foundation Choosing Wisely Campaign which has focused on identifying ways that practicing clinicians can contribute to the delivery of high-value, cost-conscious health care by recommending appropriate use of common treatments or screening and diagnostic tests. This discussion is about obtaining rest exercise electrocardiogram for screening in low-risk asymptomatic adults. It reflects the recommendations of the American Academy of Family Physicians (AAFP).
There is little evidence that screening EKGs in healthy, low-risk people will pick up silent coronary heart disease and subsequently prevent heart attacks. Rather, when screening a low-risk population, we obtain a moderate number of false-positive tests that lead to additional unnecessary and often invasive procedures. Such procedures carry real, physical risks. Physical risks aside, positive tests create worry and potentially persistent fear that “something is wrong,” even after reassurance by a subsequent test.
Who SHOULD get an EKG? There is no solid evidence-based information upon which to make a recommendation. Clinicians should routinely assess a patient’s risk for incident coronary disease. Those at higher risk (perhaps greater than 10% – 20 % 10-year Framingham risk (check out http://www.mdcalc.com/framingham-coronary-heart-disease-risk-score/) should have a baseline EKG for their charts. Many guidelines recommend a routine baseline EKG for patients with hypertension as well.
Almost all clinicians can speak to the usefulness of an “old” EKG for comparison when a patient has new chest symptoms and an equivocal cardiogram. The Choosing Wisely campaign should remind us that we do not need yearly or even regular EKG to provide good care to adult patients.
BOTTOM LINE: ROUTINE EKGs in healthy, low risk patients are unnecessary and possibly harmful.