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Task Force Updates EKG Recommendations

Low-Risk People Without Symptoms Do Not Need EKG, Group Says

Scope of the EKG Recommendations

The task force considers evidence only. The recommendations provide doctors the best evidence for a test or service.

Doctors then use their clinical judgment when deciding which tests to do.

The panel doesn't consider cost. But for the record, costs vary. A resting EKG is about $50. In 2011, Medicare reimbursed $92 for a treadmill test.

New EKG Recommendations: Perspectives

The guidelines clarify that for a low-risk person without symptoms, getting an EKG doesn't add anything, says Ravi Dave, MD, attending cardiologist at UCLA Medical Center, Santa Monica.

He reviewed the updated guidelines for WebMD.

"For intermediate to high-risk, it leaves it up to doctors," he says.

"I think doctors [sometimes] do an EKG to avoid missing a major abnormality," Dave says. "What we can get from this study is, the evidence suggests there is no need to do a routine EKG on a low-risk person without symptoms."

Suzanne Steinbaum, DO, director of women and heart disease at Lenox Hill Hospital, New York, doesn't agree totally with the new EKG recommendations.

For those who are low risk and without symptoms of heart disease, she agrees that repeated EKGs done routinely over the years are not necessary.

However, she says, "I think everyone needs an EKG at some point in their life when they are healthy."

This EKG can then serve as a comparison later, if symptoms occur and an EKG is ordered, says Steinbaum.

Routine EKGs: Other Guidelines

The American Academy of Family Physicians does not recommend routine EKGs as part of a periodic health exam in adults without symptoms.

However, the American College of Cardiology Foundation and the American Heart Association state that a resting EKG is ''reasonable" to assess risk in an adult with no symptoms who has high blood pressure or diabetes.

It can be considered in others without symptoms who don't have diabetes or high blood pressure.

An exercise EKG could be considered in those at intermediate risk without symptoms, including those just beginning to exercise vigorously, according to the same guidelines.

Heart Health: Other Steps

Lifestyle changes can improve heart health, Melnikow says.

"We know very clearly people can lower their risk of heart disease by quitting smoking, lowering their cholesterol, lowering their blood pressure if it is high, and being physically active," she says.


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