Judicious use of cardiac screening

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Unnecessary screening can have a considerable cost beyond that of the test itself, warn members of an ad hoc committee convened by the American College of Physicians.

Screening tests should be performed judiciously, and the committee has assembled a list of common clinical situations in which more testing is unlikely to be helpful and may be harmful, writes Amir Qaseem, MD, PhD, MHA, from the ACP, Philadelphia, Pennsylvania, and colleagues in the January 17, 2012, issue of the Annals of Internal Medicine.

ACP committee has identified 37 clinical scenarios in which screening does not promote patient health, and might even have adverse consequences. Among them cardiac ones are:

• Performing coronary angiography in patients with chronic stable angina who have well-controlled symptoms on medical therapy, or who lack specific high-risk criteria on exercise testing

• Routinely repeating echocardiography in asymptomatic patients with mild mitral regurgitation and normal left ventricular size and function

• Obtaining ECG to screen for cardiac disease in patients at low to average risk for coronary artery disease.

• Obtaining exercise electrocardiogram for screening low-risk, asymptomatic adults