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Task Force Updates EKG Recommendations

Low-Risk People Without Symptoms Do Not Need EKG, Group Says
By
WebMD Health News
Reviewed by Louise Chang, MD

July 30, 2012 -- If you're at low risk for heart disease and don't have symptoms such as chest pains, you do not need a routine electrocardiogram (EKG or ECG), according to updated guidelines from the U.S. Preventive Services Task Force.

If you are at intermediate or high risk but don't have symptoms, there is not enough evidence to say one way or the other whether an EKG will help predict heart disease, says Joy Melnikow, MD, PhD, a member of the task force.

The updated recommendations focus on a specific group, Melnikow says. "This recommendation addresses people without any symptoms of heart disease who are coming to their doctor to find out what they need to do to be healthier."

The task force is an independent panel of experts that considers multiple sources of evidence and makes recommendations about preventive services and tests.

The task force focused on just the EKG, which checks for problems with the heart's electrical activity. It is often done to find the cause of symptoms such as chest pain. An EKG can be a resting EKG or an exercise EKG, also called a treadmill test.

The task force looked at evidence gathered since 2004. The updated EKG recommendations echo the previous ones.

Other organizations differ in their recommendations.

The task force guidelines are published in the Annals of Internal Medicine.

EKG Recommendations in Detail

The panel asked one question, says Melnikow, professor of family and community medicine at the University of California, Davis. "Once [a person is] evaluated for other risk factors for heart disease -- such as smoking, high cholesterol, sedentary lifestyle, high blood pressure -- does it help to add a screening test with either a resting ECG or an exercise ECG?"

"Our answer is, the net benefit of that is zero or possibly slight harm in low-risk people," Melnikow says.

Among the possible harms are false-positive EKGs. Those could lead to unnecessary procedures such as angioplasty, she says.

For intermediate- and high-risk adults, the evidence was not sufficient to make a recommendation, the task force says.

More About Risk Categories

Your doctor can estimate your risk by using your total cholesterol, HDL or "good" cholesterol, and blood pressure numbers along with information such as age, gender, and smoking history.

"You are at low risk if you have less than a 10% risk of heart attack or death from coronary heart disease in the next 10 years," Melnikow says.

Those with a 10% to 20% risk of heart disease in the next 10 years are at intermediate risk. A 10-year risk greater than 20% is high risk.

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