Screening asymptomatic adults for coronary heart disease with resting or exercise electrocardiography systematic review to update the 2004 U.S. Preventive Services Task Force Recommendation ; prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Oregon Evidence-based Practice Center, Oregon Health & Science University ; investigators, Roger Chou
Two studies found that resting or exercise ECG findings plus traditional risk factor assessment resulted in a slight increase in the C statistic compared with traditional risk factor assessment alone. Twenty-seven prospective cohort studies (10 rated good quality) with over 170,000 subjects evaluate...
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| Corporate Authors: | , , |
| Format: | eBook |
| Language: | English |
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Rockville, MD
Agency for Healthcare Research and Quality
2011, 2011
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| Series: | Evidence syntheses
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| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | Two studies found that resting or exercise ECG findings plus traditional risk factor assessment resulted in a slight increase in the C statistic compared with traditional risk factor assessment alone. Twenty-seven prospective cohort studies (10 rated good quality) with over 170,000 subjects evaluated resting ECG abnormalities and 38 prospective cohort studies (19 rated good quality) with over 90,000 subjects evaluated exercise ECG abnormalities as predictors of subsequent cardiovascular events, after adjusting for traditional risk factors. CONCLUSIONS: Abnormalities on resting or exercise ECG are associated with an increased risk of subsequent cardiovascular events after adjusting for traditional risk factors, but the clinical implications of these findings are unclear BACKGROUND: Coronary heart disease is the leading cause of death in the United States in adults. Traditional risk factors do not account for all of the excess risk associated with coronary heart disease. Screening for abnormalities with resting or exercise electrocardiography (ECG) could help identify persons at higher risk for coronary heart disease who might benefit from interventions to reduce cardiovascular risk. PURPOSE: To update the 2004 U.S. Preventive Services Task Force (USPSTF) evidence review on screening for resting or exercise ECG abnormalities in asymptomatic adults. DATA SOURCES: We searched Ovid MEDLINE from January 2002 through January 2011 and the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials through the fourth quarter of 2010. We supplemented electronic searches with reviews of reference lists, including prior USPSTF reviews. STUDY SELECTION: We included randomized controlled trials and prospective cohort studies that evaluated benefits or harms of screening compared with no screening in asymptomatic adults, or evaluated use of interventions to reduce cardiovascular risk (lipid-lowering therapy and aspirin) in screened persons compared with unscreened persons. We included prospective cohort studies that evaluated the usefulness of screening for abnormalities with resting or exercise ECG for predicting subsequent cardiovascular events, after controlling for at least five of the seven Framingham risk factors. DATA EXTRACTION: Data were abstracted by two investigators and discrepancies were resolved by consensus. Quality was assessed based on methods developed by the USPSTF. DATA SYNTHESIS (RESULTS): No study evaluated benefits of screening compared with no screening, or use of lipid-lowering therapy or aspirin following screening. No study estimated effects of screening on reclassification. Pooled analyses showed that abnormalities on resting (ST segment abnormalities, T wave abnormalities, ST segment or T wave abnormalities, left ventricular hypertrophy, bundle branch block, left axis deviation) or exercise (ST segment depression with exercise, failure to reach maximum target heart rate, low exercise capacity or fitness) ECG were associated with increased risk of subsequent cardiovascular events, after adjusting for traditional risk factors (pooled hazard ratio estimates from 1.4 to 2.1). Evidence on direct harms associated with screening with resting or exercise ECG is very limited, but direct harms appear minimal (resting ECG) or small (exercise ECG). No study estimated risks of downstream harms associated with subsequent testing or interventions, though rates of angiography after exercise ECG ranged from 0.6 to 2.9 percent. LIMITATIONS: We only included English-language studies. Statistical heterogeneity was present in several of the pooled analyses. |
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| Item Description: | "September 2011." |
| Physical Description: | 1 PDF file (vii, 127 p.) ill |