Grand Rounds

Should We Be Ordering ECGs as Part of an Annual Health Exam?

BACKGROUND AND PURPOSE:

Guidelines do not recommend routine ECGs in low risk individuals, but the data behind this guidance is limited
Bhatia et. al. (JAMA Internal Medicine, 2017) looked at
- How often ECGs were ordered in low risk individuals
- Cardiac testing and clinical outcomes in low-risk patients who did and did not receive an ECG after their annual health exam (AHE)

Population-based retrospective cohort study
3,629,859 (>18 years) primary care patients
Low-risk (no prior cardiac history or risk factors)
Primary outcome
- Downstream cardiac testing or consultation with a cardiologist
Secondary outcomes
- Death
- Hospitalization
- Revascularization at 12 months (e.g., angioplasty or bypass)

21.5% of patients had an ECG within 30 days of AHE with very large range (1.1% – 94.9% among primary care physicians)
Primary outcome
- Patients who had ECG were significantly more likely to receive additional cardiac tests, visits, or procedures
  - odds ratio 5.14 (95% CI, 5.07-5.21; P < .001)
Secondary outcomes, comparing ECG to non-ECG cohorts
- Rates of death were 0.19% vs 0.16%
- Rates of cardiac-related hospitalizations were 0.46% vs 0.12%
- Coronary revascularizations were 0.20% vs 0.04%

Despite recommendations, ECG testing after an AHE is relatively common, with large variation
This study demonstrated cardiac event rates < 1% in both groups, despite higher rates of cardiovascular investigations in the ECG group
This data lends further evidence to the guidelines that recommend against routine ECGs in low-risk patients

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