The US Preventative Services Task Force has released their new recommendations on screening for heart disease in low-risk patients. In a word: don't do it.
The recommendations, due to be published in April in the Annals of Internal Medicine, were released publicly last week on-line.
The task force reviewed evidence from published studies examining whether screening low-risk, asymptomatic patients for underlying coronary artery disease or other heart disease yields improved those patients' outcomes. They looked at the use of ECGs and stress tests, as well as the measuring of coronary artery calcium scores with EBCT scans. Their conclusion: evidence is "insufficient" that such screening improves clinical outcomes; and furthermore, patients who are screened are exposed to the risks associated with false positive results. ("False positive" results suggest the presence of disease when, in fact, there is no disease.) False positive results can lead to the performance of unnecessary invasive procedures (such as cardiac catheterization,) the administration of inappropriate treatment, and inappropriately labeling healthy individuals as heart patients. (If you don't think this is a problem, try buying insurance after you've been written up as a cardiac patient.) The bottom line: forget the screening tests and rely on the simpler, more traditional risk factor assessment- smoking, cholesterol, diet, obesity, diabetes, activity levels, etc.
The task force's recommendations are bound to create controversy. It is likely that many prominent cardiologists - and possibly the American Heart Association - will react negatively to them. While it is true that no randomized clinical trials have proven the benefit of such screening tests, it is also true that the benefits of traditional risk factor screening (which the task force endorses) also have not been "proven." Deciding whether it is worthwhile to screen extensively for heart disease is an individual decision -between a doctor and patient. As long as a patient understands the risks associated with a false positive screening test, and still wishes to proceed, it is not at all clear that they should be prevented from doing so.
The task force looked at this problem from a societal level - not from the perspective of the individual. For society, widespread screening tests would clearly be bad. Sure, if such screening were done, occasionally a person would be found with undiagnosed heart disease, and treating that heart disease might save his/her life (and a bit of money over the long-term.) But summed all together, broad screening of the population might well cause more harm than good - and would certainly be very, very expensive.
The US Preventative Services Task Force, by the way, is a limb of the Agency for Healthcare Research and Quality, i.e., the Feds - the ones who are going to have to pay for all this screening.
