News | ECG | July 20, 2017

More Than 20 Percent of Low-Risk Patients Receive Annual ECG

New study notes five times greater likelihood of downstream testing and costs for relatively healthy group of patients

More Than 20 Percent of Low-Risk Patients Receive Annual ECG

July 20, 2017 — More than one in five Ontario patients receive an electrocardiogram (ECG) during their annual health exam despite being at low risk for heart disease, according to a new study from the Institute for Clinical Evaluative Sciences (ICES).

An ECG is a common test used to record the electrical signals of the heart; the results of an ECG can provide information about the structure and function of the heart.

“An ECG is a valuable test that can save a patient’s life if they are experiencing chest pains or are at high risk of heart disease, but there is little value when patients are at low risk of cardiovascular disease and this certainly should not be a routine test as part of an annual physical exam,” said Sacha Bhatia, M.D., a scientist at ICES, cardiologist and director at Women’s College Hospital Institute for Health System Solutions and Virtual Care (WIHV).

The study, published in JAMA Internal Medicine, shows that low-risk patients who had an ECG were five times more likely to receive another diagnostic test like a stress test, echocardiogram or a cardiology consultation than those who did not have an ECG.

“Our findings show that ECGs conducted on patients as part of an annual health exam are common, and the downstream effect is an increased risk for subsequent cardiology testing and consultation cascade, even though the overall cardiac event rate in this group was very low,” added Bhatia.

The Choosing Wisely campaign, launched in 2012, recommends against non-invasive cardiac testing in low-risk and asymptomatic patients. ECGs are in their “top five” lists of low-value tests, treatments and procedures that physicians and patients should question.

The study of 3,629,859 adult patients who had at least one annual health exam between fiscal years 2010/2011 and 2014/2015 in Ontario found:

  • ECGs ordered in low-risk patients as part of the annual health exam are common, occurring in 21 percent of patients;
  • There is wide variation in physician ordering, with more than 7 percent of family physicians ordering ECGs in more than 50 percent of their low-risk patients;
  • In low-risk patients who had an ECG, they were five times more likely to receive another test (like a stress test, echocardiogram) or cardiology consultation than those who did not; and
  • Patients that did or did not receive an ECG had a very low risk of death, hospitalizations or revascularization (<0.5 per cent) at the one-year mark.

“Our findings suggest that even low-cost procedures like ECGs in low-risk patients, occur with significant frequency, and importantly can lead to more advanced testing that ends up costing the health system more with little potential benefit to patients,” said Bhatia.

For more information: www.jamanetwork.com/journals/jamainternalmedicine

Related Content

Evolutionary Gene Loss May Help Explain Human Predisposition to Heart Attacks
News | Cardiac Diagnostics | July 29, 2019
The loss of a single gene two to three million years ago in our ancestors may have resulted in a heightened risk of...
U.S. Soldiers Have Worse Heart Health Than Civilians
News | Cardiac Diagnostics | June 06, 2019
Active duty Army personnel have worse cardiovascular health compared to people of similar ages in the civilian...
Late Dinner and No Breakfast Worsens Outcomes After Heart Attack
News | Cardiac Diagnostics | May 23, 2019
People who skip breakfast and eat dinner near bedtime have worse outcomes after a heart attack, according to research...
HRS Releases New Expert Consensus Statement on Arrhythmogenic Cardiomyopathy
News | Cardiac Diagnostics | May 14, 2019
The Heart Rhythm Society (HRS) released a first-of-its-kind consensus statement with guidance on the evaluation and...
New Best Practices Help Manage Heart Attack Patients Without Significant Signs
News | Cardiac Diagnostics | April 15, 2019
For the first time in the United States, doctors with the American Heart Association (AHA) have outlined best practices...
The most recent U.S. Food and Drug Administration (FDA) clearance was Siemens Healthineers high-sensitivity troponin I assays (TnIH) for the Atellica IM and ADVIA Centaur XP/XPT in vitro diagnostic analyzers. The test helps in the early diagnosis of myocardial infarctions without the need for serial tropic testing. The time to first results is 10 minutes.

The most recent U.S. Food and Drug Administration (FDA) clearance was Siemens Healthineers high-sensitivity troponin I assays (TnIH) for the Atellica IM and ADVIA Centaur XP/XPT in vitro diagnostic analyzers. The test helps in the early diagnosis of myocardial infarctions without the need for serial tropic testing. The time to first results is 10 minutes. 

Feature | Cardiac Diagnostics | March 22, 2019 | Linda C. Rogers, Ph.D.
Troponins are a family of proteins found in skeletal and heart (cardiac) muscle fibers that produce muscular contract
ACC/AHA Update Guidance for Preventing Heart Disease; Stroke
Feature | Cardiac Diagnostics | March 18, 2019
The choices we make every day can have a lasting effect on our heart and vascular health. Adopting a heart healthy...
AHA Statement Warns Hookah Smoking May Harm the Heart
News | Cardiac Diagnostics | March 08, 2019
Smoking tobacco in waterpipes, more commonly known as hookahs, results in inhaling toxic chemicals, often at levels...
PTSD Alone Does Not Increase Heart Disease Risk in Veterans
News | Cardiac Diagnostics | February 20, 2019
February 20, 2019 — Post-traumatic stress disorder (PTSD) by itself does not explain the...
Overlay Init