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#Grand Rounds

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

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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) 

METHODS: 

  • 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) 

RESULTS: 

  • 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% 

CONCLUSION: 

  • 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

Learn More – Primary Sources:  

Electrocardiograms in Low-Risk Patients Undergoing An Annual Health Examination

USPSTF: Coronary Heart Disease – Screening with Electrocardiography

Don’t Use Screening ECG to Predict Coronary Events in Low-Risk Adults, Say AAFP, USPSTF

 

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