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Screening for Asymptomatic Coronary Artery Disease
Systematic Evidence Reviews, No. 22
Michael Pignone, MD, MPH, Angela Fowler-Brown, MD, Mark Pletcher, MD, MPH, and Jeffrey A Tice, MD.
Author Information and AffiliationsStuctured Abstract
Background:
We reviewed the evidence on the value of screening asymptomatic patients with resting electrocardiogram (ECG), exercise electrocardiogram treadmill test (ETT), or electron beam computerized tomography (EBCT).
Methods:
We searched MEDLINE 1966 - June 2002 to identify studies examining the independent value of ECG, ETT, and EBCT in patients with no known history of cardiovascular events. We sought to identify studies that examined the use of these tests compared with traditional risk assessment of coronary heart disease (CHD) as a means of reducing CHD events, improving the use of CHD risk-reducing treatments, or producing more accurate assessments of actual CHD risk.
Results:
No studies examined the effect of screening asymptomatic patients with ECG, ETT, or EBCT on CHD outcomes. Two fair quality studies examined the effect of a positive EBCT on self-reported adoption of risk-reducing behaviors and found mixed results. ECG, ETT, and EBCT each can provide independent prognostic information about the risk of CHD events, mainly in middle-aged or older adults, but the effect of this information on clinical decisionmaking is unclear. When the risk of CHD events is low, however, most positive findings will be false positives and may result in unnecessary further testing.
Conclusions:
Although ECG, ETT, and EBCT can provide prognostic information about the risk of future CHD events, the effect of this information on clinical management or disease outcomes in asymptomatic patients is unclear.
Contents
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-97-0011, Task Order No. 3, Technical Support of the U.S. Preventive Services Task Force. Prepared by: Research Triangle Institute-University of North Carolina Evidence-based Practice Center, Research Triangle Park, North Carolina.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
AHRQ is the lead Federal agency charged with supporting research designed to improve the quality of health care, reduce its cost, address patient safety and medical errors, and broaden access to essential services. AHRQ sponsors and conducts research that provides evidence-based information on health care outcomes; quality; and cost, use, and access. The information helps health care decisionmakers—patients and clinicians, health system leaders, and policymakers—make more informed decisions and improve the quality of health care services.
The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services of a particular drug, device, test, treatment, or other clinical service.
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