Electrocardiogram screening in asymptomatic adults

Abstract

Objective: To perform a critical analysis of review papers and guidelines of cardiology and preventive medicine in order to assess the efficacy of the resting electrocardiogram (ECG) as a screening tool fort heart disease in asymptomatic adults in the ambulatory setting. Methods: A systematic review of PubMed (1985-2003) was performed. Paper evaluated fulfilled the following criteria: (1) Papers referring exclusively to subjects aged 19 or more and apparently healthy; (2) papers evaluating solely the efficacy of the resting 12 derivation ECG as a screening tool for heart disease; papers in English. Levels of evidence were attributed according to the scale of the Canadian Task Force on the Periodic Health Examination. Guidelines by leading authorities were also searched online. Conclusions: All papers reviewed indicate that the resting ECG has neither sensitivity nor specificity enough to serve as a screening tool for cardiovascular disease in apparently healthy adults; its use as such should thus be abandoned, reducing health care costs. Steps should be taken to reduce risk factors for ischaemic disease, the only intervention shown to reduce both morbidity and mortality in this population. This review, however, was based in non-randomised studies, having thus a low scientific evidence level. The lack of efficacy of the resting ECG as a routine screening tool in apparently healthy adults should be confirmed by controlled randomised studies.