Heart disease is the leading killer in the U.S., so you might assume keeping close tabs on your heart with routine exercise stress tests, or electrocardiogram screenings (EKGs), is a no-brainer. That may be true if you already have heart disease or certain risk factors, like diabetes. But we've long advised that EKGs are usually not a good idea for healthy adults without symptoms of heart disease. And that view was confirmed today by a new report from the U.S. Preventive Services Task Force.
No organization recommends EKGs for low-risk adults, according to the Task Force, but it reports that such tests are nevertheless performed with "some frequency." Likewise, a 2010 Consumer Reports survey of nearly 1,200 people between the ages of 40 and 60 with no history of heart disease or heart-disease symptoms, found that 39 percent said they had undergone an EKG during the previous five years and 12 percent said they had an exercise stress test.
Most of them probably shouldn't have. The Task Force's new review of evidence to date found that screening low-risk adults without symptoms of heart disease was "highly unlikely" to help reduce heart attacks and other cardiac events.
The researchers did find evidence, however, that screening low-risk adults can lead to harm, such as unnecessary invasive procedures, overtreatment, as well as anxiety. That's because the tests aren't as accurate on low-risk adults, and can lead to further tests and treatments. All of which can also be a waste of money.
Bottom line: EKGs and exercise stress tests may be necessary if you have chest pain, shortness of breath, an irregular heartbeat or palpitations, or other symptoms of heart disease. They can also be a good idea if you have diabetes or other risk factors, and possibly if you're middle aged or older, sedentary, and are just starting an exercise program. But if you don't have any risk factors for heart disease, think twice before undergoing an EKG.
You can find out more about the screening tests you should, and shouldn't, get in our guide to a healthy heart, including our advice on EKGs. Also see our Choosing Wisely report on EKGs (PDF), prepared in collaboration with the American Academy of Family Physicians, the ABIM Foundation, and the National Physicians Alliance. Choosing Wisely is a campaign to help educate and encourage physicians, patients and others to think and talk about medical tests and procedures that may be unnecessary, and that may cause harm.
Task Force Recommends Against Screening ECG for Asymptomatic Adults at Low Risk for Coronary Heart Disease [Annals of Internal Medicine]