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screening for coronary artery disease

Management: 1) USPSTF & ACP recommend against screening asymptomatic, low-risk adults with: a) resting electrocardiogram b) exercise stress test c) electron-beam computed tomography [1,2] d) stress echocardiography e) stress myocardial perfusion imaging [3] 2) insufficient evidence to recommend for or against screening in higher-risk patients [1,2] - routine screening in asymptomatic patients with diabetes mellitus does not reduce mortality [4] 3) American College of Physicians recommends against screening 3) ECG testing doesn't offer improved risk stratification over conventional risk factors such as obesity, hypertension, & lipodystrophy among those at low risk, the USPSTF concluded. For all risk categories, 4) ECG screening could lead to unnecessary procedures & overtreatment [2] 5) see cardiac risk assessment & cardiovascular risk calculator

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cardiac risk assessment

General

screening for heart disease

References

  1. Journal Watch 24(9):74, 2004 U.S. Preventive Services Task Force. Screening for coronary heart disease: recommendation statement. Ann Intern Med. 2004 Apr 6;140(7):569-72. PMID: 15068986 - USTSTF http://www.ahrq.gov/clinic/3rduspstf/chd/chdrs.htm - Fowler-Brown A, Pignone M, Pletcher M, Tice JA, Sutton SF, Lohr KN; U.S. Preventive Services Task Force. Exercise tolerance testing to screen for coronary heart disease: a systematic review for the technical support for the U.S. Preventive Services Task Force. Ann Intern Med. 2004 Apr 6;140(7):W9-24. Review. PMID: 15069009 - Fowler-Brown A et al http://www.ahrq.gov/clinic/3rduspstf/chd/chdsum.htm
  2. Moyer VA et al Screening for Coronary Heart Disease With Electrocardiography: U.S. Preventive Services Task Force Recommendation Statement Annals of Internal Medicine, July 31, 2012 PMID: 22847227 http://annals.org/article.aspx?articleid=1262305 (corresponding NGC guideline withdrawn Feb 2018)
  3. Chou R for the High Value Care Task Force of the American College of Physicians. Cardiac Screening With Electrocardiography, Stress Echocardiography, or Myocardial Perfusion Imaging: Advice for High-Value Care From the American College of Physicians. Ann Intern Med. 2015;162(6):438-447. PMID: 25775317 http://annals.org/article.aspx?articleid=2197181
  4. Medical Knowledge Self Assessment Program (MKSAP) 17, 19 American College of Physicians, Philadelphia 2015, 2022
  5. Chou R, Arora B, Dana T, Fu R, Walker M, Humphrey L. 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. Agency for Healthcare Research and Quality (US); 2011 Sep. Report No.: 11-05158-EF-1. U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews. PMID: 21977523 Free Books & Documents, Free full text