The U.S. Preventive Services Task Force found no clear evidence that the benefits of routine ECG screening — either for atrial fibrillation or for overall cardiovascular disease risk in individuals without obvious symptoms — outweigh the risks of overtreatment. In a draft recommendation released earlier this week, the Task Force also acknowledged new devices, such as wearable ECG technology, that have the capability to assess heart rhythm but did not offer a specific recommendation on them.
Here’s what two experts have to say about ECG screening and if the advent of wearable devices, allowing patients to self-screen without guidance from a physician, will help or harm patient health.
How do you view the balance of benefits and risks for in-office ECG screening of patients without symptoms?
Steven E. Nissen, MD, MACC, Cleveland Clinic Foundation: I agree with the USPSTF that there is no compelling evidence for performing routine ECG screening in asymptomatic patients.
John Bisognano, MD, PhD, of University of Rochester Medical Center: I see no downside in screening asymptomatic in-office patients for atrial fibrillation. An ECG is virtually risk-free and the so-called “harms” mentioned (misdiagnosis, over-treatment, etc. ) would be infrequent at worst. Atrial fibrillation is a condition that is often asymptomatic and is worth finding as it has treatments that can yield a net decrease in disastrous consequences. Sure, we’ll find more — and that is a good thing. Not every medical intervention needs to be proven beneficial with rigorous and costly large-scale randomized outcome trials; some benefits are obvious.
What risk factors other than symptoms might prompt you to suggest ECG screening for a given patient?
Bisognano: Risk factors such as hypertension or a history of heart failure might support ECG screening for an individual patient. Age may also make an impact.
Will availability of ECG wristbands etc. provide an overall public health benefit, or will there be too many false positives and/or false negatives?
Nissen: With regard to “ECG wristbands” the risks of over-diagnosis will likely exceed any potential benefits. Frankly, I don’t even favor use of HR trackers for patients who exercise. There are no well-documented benefits.
Bisognano: Whenever a new health technology available to the public comes out, it has often been welcomed with concerns that it will be over-used and cause people to become too focused on their health (which, quite conversely, is often something that we wish they would do!). Many people felt this way with home blood pressure cuffs and blood pressure kiosks in stores and public area, but these devices have yielded a useful awareness in people about the importance of blood pressure treatment. In fact, the most appropriate treatment of blood pressure may be based on the numbers that these public and home devices yield — as they allow us to diagnose white-coat and masked hypertension in patients who would have previously received suboptimal treatment.