Should an electrocardiogram be a regular part of your annual exam? A study out today in the Journal of the American Association says maybe, if you're 70 or older. But we don't think so, and an accompanying editorial agrees—and even quotes us saying so.
The authors of the JAMA study acknowledge that routine EKGs in people 70 and younger without symptoms of heart disease don't make sense, since in them the test is often inaccurate and more likely to lead to unnecessary and expensive follow-up tests and treatment than needed care. For those reasons, in fact, routine EKGs were included in a list from the American Academy of Family Physicians of five commonly overused procedures. And we recently prepared a report on the overuse of EKGs (PDF) for the organization, as part of a campaign called Choosing Wisely.
But the authors of the new study argued that the test might be worthwhile in healthy people 65 and older, since established risk factors, like high blood pressure and cholesterol levels, aren't as predictive in those people as they are in younger ones. So they looked 2,192 adults ages 70 to 79 years without known cardiovascular disease. Those who had an EKG abnormality at the beginning of the study were more likely to have a heart attack or other coronary event over the next eight years. Moreover, the test helped identify people who were at lower risk of having a heart problem, the researchers said.
That might seem to argue in favor of making EKGs standard in seniors. But in the accompanying editorial, Philip Greenland, M.D., at Northwestern University in Chicago, says not so fast, for several reasons.
First, he points out that the results need to be confirmed in a larger, longer study, in which some people who get screened are actually compared with those who don't. Such randomized clinical trials are the gold standard for medical research.
Second, he says that the results of this study might not be matched by real-life experience, since EKG interpretation in routine medical care seems to be less accurate than it is in the context of research studies.
In addition, he worries that using EKGs to identify older people at lower risk of heart disease who don't need treatment might actually end up reducing the number of heart attacks prevented.
Finally, even when an EKG does identify people at higher risk, they would still be urged to do what they are already urged to do: control high blood pressure and cholesterol levels, lose excess weight, manage diabetes, quit smoking, and consider low-doses of aspirin.
For all of those reasons, Greenwald argues for sticking with the current recommendations from the American College of Cardiology, the American Heart Association, and the U.S. Preventive Services Task Force, and, he writes, "even Consumer Reports." Those recommendations advise against routine screening with an EKG in healthy people without symptoms of heart disease, regardless of age.
John Santa, M.D., director of the Consumer Reports Health Ratings Center, says "After looking at the study we don't feel a change in our ratings of EKG is needed," he says. "Compared with other screening and treatment strategies for heart disease, and EKG is a low priority at best and should likely be avoided in routine screening since it can confuse in some cases.
Association of Major and Minor ECG Abnormalities With Coronary Heart Disease Events [JAMA]
Should the Resting Electrocardiogram Be Ordered as a Routine Risk Assessment Test in Healthy Asymptomatic Adults? [JAMA]