Thursday, April 19, 2012
Choose Wisely: An EKG?
Should an EKG (electrocardiogram- the heart tracing) be a ROUTINE part of your annual physical? NO- not unless you have risk factors that suggest otherwise! I am blogging this month about the American Academy of Family Physician's recommendations for tests and procedures that patients and doctors should question. The Choosing Wisely campaign is focusing attention across specialties to look at evidence-based recommendations that should be discussed to help make better decisions for patient health & health dollars.
So what about the heart tracing? Well, it turns out that there is little evidence that pure screening EKGs in healthy, low-risk people will pick up silent coronary heart disease and subsequently prevent heart attacks. Instead, what we see is a moderate number of false-positive tests that lead to additional unnecessary and often invasive procedures.
Who SHOULD get EKG's? Risk factors for coronary disease include high blood pressure, high "bad" (LDL) cholesterol or low "good" (HDL) cholesterol, smoking, family history of heart disease, diabetes, males over age 45 & women over 55, and obesity. The more risk factors you have, the higher your risk, and the more likely it is that your doctor will indeed recommend an EKG at your office visit.
Check out the other AAFP Recommendations: Bone Density Test, Sinus Infection treatment, and Back X-rays
BOTTOM LINE: ROUTINE EKGs in healthy, low risk patients are unnecessary and possibly harmful- skip this test unless you & your doctor determine you are at risk for heart disease!