MedicalResearch.com Interview with:
Dr. Michael Barry MD
Director of the Informed Medical Decisions Program
Health Decision Sciences Center at Massachusetts General Hospital
Physician at Massachusetts General Hospit
Professor of Medicine,Harvard Medical School
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Cardiovascular disease (CVD), which can lead to heart attack and stroke, causes 1 in 3 deaths among adults in the United States. The Task Force reviewed the latest research on whether adding an electrocardiogram—or ECG, which is a test that records a person’s heart activity—to the standard ways we measure CVD risk can help prevent heart attack and stroke in people who do not have symptoms and are generally healthy, as well as people who are already at risk for these conditions.
The evidence shows that adding screening with ECG to the ways we already measure CVD risk is unlikely to help prevent heart attack or stroke in people at low risk. It can also cause harms—such as those from follow-on procedures like angiography and angioplasty, which can lead to heart attack, kidney failure, and even death. As a result, the Task Force recommends against screening with ECG for this group.
For those who might benefit the most—people who are already at medium or high risk of CVD—there is not enough evidence to say whether or not adding screening with an ECG to standard care helps prevent heart attack and stroke. This is an area where we need more research.
MedicalResearch.com: What should readers take away from your report?
Response: For patients at low risk of CVD, clinicians should not add ECG screening to standard CVD risk measurement tools. We need more studies that tell us how effective ECG screening is at detecting risk for heart attack and stroke in higher-risk patients when added to standard care. For both groups, clinicians should continue to use the established risk assessment tools that have already proven to be effective.
There are traditional risk factors and assessment tools that clinicians can—and already do—use to estimate risk for CVD. The Task Force recommends that clinicians use the Pooled Cohort Equations to assess a patient’s risk for CVD events. The Pooled Cohort Equations include the following traditional risk factors in their calculation: age, sex, smoking status, cholesterol, blood pressure, race, ethnicity, and whether or not the patient has diabetes
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: More studies are needed that look at the value of adding resting or exercise ECG tests to standard risk assessment tools so we can better understand whether they can help clinicians decide which patients would benefit from treatment. For example, we need to know if adding ECG testing to standard risk assessment tools can help to correctly re-classify someone into a higher or lower risk category. It would also be worthwhile to examine how accurately adding ECG testing can predict which people without symptoms are most likely to have a heart attack or stroke. The information these studies would provide could help guide treatment decisions in a more precise way.
MedicalResearch.com: Is there anything else you would like to add?
Response: Until more evidence is available, clinicians should continue to use traditional risk factors (such as age, race, and smoking status) as well as the Pooled Cohort Equations to assess CVD risk and decide which of their patients should receive risk-based treatment. Clinicians should use their best medical judgement to make the appropriate screening and treatment decisions for their patients. Anyone concerned about their risk for a heart attack or stroke should talk to their doctor.
US Preventive Services Task Force. Screening for Cardiovascular Disease Risk With ElectrocardiographyUS Preventive Services Task Force Recommendation Statement. JAMA. 2018;319(22):2308–2314. doi:10.1001/jama.2018.6848
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