Screening for Cardiovascular Disease Risk With Electrocardiography

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Abstract

Cardiovascular disease (CVD), which encompasses atherosclerotic conditions such as coronary heart disease, cerebrovascular disease, and peripheral arterial disease, is the most common cause of death among adults in the United States. Treatment to prevent CVD events by modifying risk factors is currently informed by CVD risk assessment with tools such as the Framingham Risk Score or the Pooled Cohort Equations, which stratify individual risk to inform treatment decisions.

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Most cited references 19

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Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US Preventive Services Task Force Recommendation Statement.

Kirsten Bibbins-Domingo, David Grossman, Susan Curry … (2016)

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States, accounting for 1 of every 3 deaths among adults.

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Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement.

Albert L Siu (2015)

Update of the 2007 U.S. Preventive Services Task Force (USPSTF) reaffirmation recommendation statement on screening for high blood pressure in adults.

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ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons.

M Wolk, R. Patel, Leon Shaw … (2014)

The American College of Cardiology Foundation along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical presentations for stable ischemic heart disease (SIHD) to consider use of stress testing and anatomic diagnostic procedures. This document reflects an updating of the prior Appropriate Use Criteria (AUC) published for radionuclide imaging (RNI), stress echocardiography (Echo), calcium scoring, coronary computed tomography angiography (CCTA), stress cardiac magnetic resonance (CMR), and invasive coronary angiography for SIHD. This is in keeping with the commitment to revise and refine the AUC on a frequent basis. A major innovation in this document is the rating of tests side by side for the same indication. The side-by-side rating removes any concerns about differences in indication or interpretation stemming from prior use of separate documents for each test. However, the ratings were explicitly not competitive rankings due to the limited availability of comparative evidence, patient variability, and range of capabilities available in any given local setting. The indications for this review are limited to the detection and risk assessment of SIHD and were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Eighty clinical scenarios were developed by a writing committee and scored by a separate rating panel on a scale of 1 to 9, to designate Appropriate, May Be Appropriate, or Rarely Appropriate use following a modified Delphi process following the recently updated AUC development methodology. The use of some modalities of testing in the initial evaluation of patients with symptoms representing ischemic equivalents, newly diagnosed heart failure, arrhythmias, and syncope was generally found to be Appropriate or May Be Appropriate, except in cases where low pre-test probability or low risk limited the benefit of most testing except exercise electrocardiogram (ECG). Testing for the evaluation of new or worsening symptoms following a prior test or procedure was found to be Appropriate. In addition, testing was found to be Appropriate or May Be Appropriate for patients within 90 days of an abnormal or uncertain prior result. Pre-operative testing was rated Appropriate or May Be Appropriate only for patients who had poor functional capacity and were undergoing vascular or intermediate risk surgery with 1 or more clinical risk factors or an organ transplant. The exercise ECG was suggested as an Appropriate test for cardiac rehabilitation clearance or for exercise prescription purposes. Testing in asymptomatic patients was generally found to be Rarely Appropriate, except for calcium scoring and exercise testing in intermediate and high-risk individuals and either stress or anatomic imaging in higher-risk individuals, which were all rated as May Be Appropriate. All modalities of follow-up testing after a prior test or percutaneous coronary intervention (PCI) within 2 years and within 5 years after coronary artery bypass graft (CABG) in the absence of new symptoms were rated Rarely Appropriate. Pre-operative testing for patients with good functional capacity, prior normal testing within 1 year, or prior to low-risk surgery also were found to be Rarely Appropriate. Imaging for an exercise prescription or prior to the initiation of cardiac rehabilitation was Rarely Appropriate except for cardiac rehabilitation clearance for heart failure patients.

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Author and article information

Journal

Title: JAMA

Abbreviated Title: JAMA

Publisher: American Medical Association (AMA)

ISSN (Print): 0098-7484

Publication date Created: June 12 2018

Publication date (Print): June 12 2018

Volume: 319

Issue: 22

Page: 2308

Affiliations

[1 ]University of Iowa, Iowa City

[2 ]Fairfax Family Practice Residency, Fairfax, Virginia

[3 ]Virginia Commonwealth University, Richmond

[4 ]Veterans Affairs Palo Alto Health Care System, Palo Alto, California

[5 ]Stanford University, Stanford, California

[6 ]Harvard Medical School, Boston, Massachusetts

[7 ]Oregon Health & Science University, Portland

[8 ]Columbia University, New York, New York

[9 ]University of Pennsylvania, Philadelphia

[10 ]Virginia Tech Carilion School of Medicine, Roanoke

[11 ]Nationwide Children’s Hospital, Columbus, Ohio

[12 ]Temple University, Philadelphia, Pennsylvania

[13 ]University of Alabama at Birmingham

[14 ]University of California, Los Angeles

[15 ]Boston University, Boston, Massachusetts

[16 ]Northwestern University, Evanston, Illinois

[17 ]University of Hawaii, Honolulu

[18 ]Pacific Health Research and Education Institute, Honolulu, Hawaii

[19 ]Tufts University, Medford, Massachusetts

Article

DOI: 10.1001/jama.2018.6848

PubMed ID: 29896632

SO-VID: 018f79a3-49d8-4b6f-8536-321ec4e45429

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Screening for Cardiovascular Disease Risk With Electrocardiography : US Preventive Services Task Force Recommendation Statement

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Most cited references 19

Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US Preventive Services Task Force Recommendation Statement.

Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement.

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