A low-tech focus on preventive medicine, not an investment in or a utilization of higher-tech diagnostic technology, is the preferred path for screening patients for heart disease when they show no symptoms and are part of a low-risk population, a member of a federal public health panel recommends.
Meanwhile, the U.S. Preventive Services Task Force, sponsored by the Agency for Healthcare Research and Quality, says treadmill testing, electrocardiograms and even electron beam computerized tomography all have their place, but they probably will do more harm than good if used to screen patients at low-risk for heart disease.
Instead, with men under age 50 and women under age 60, physicians should first focus on advising them to maintain an appropriate weight, to monitor blood pressure and cholesterol and to quit smoking, according to task force member Paul Frame, M.D..
"We're not saying treadmill testing and EKG and even electron beam CT scans are bad tests," said Frame, clinical professor of family medicine at University of Rochester School of Medicine in Rochester, N.Y. "We are saying the potential harm outweighs the benefits."
A calculator to monitor risk of heart disease is at the National Heart, Lung and Blood Institute Web site.
"Both the EKGs and, to a lesser extent, the stress test in a low-risk population are not so good as a predictor as they are in telling you already have the disease," Frame said.
Not only will the inevitable false positives in low-risk individuals rattle patients needlessly, they often will lead to drug treatment or invasive coronary angiography, each with added risk, the panel concluded.
On balance, Frame said, "In a low-risk population, the risk of false positive is many times greater than indicating a true positive."
"The message we're trying to convey, for the low risk persons the emphasis is on identifying and treating risk factors and that screening is not valuable."
Frame practices with the Tri County Family Medicine, a 12-physician group with seven offices in rural communities outside Rochester and has been researching and writing about public health issues for nearly 30 years.
The task force assigns grades based on the strength of evidence, with "A" for strongly recommends, "B" recommends, "C" no recommendation, "D" recommends against and "I" insufficient evidence to recommend for or against.
According to the task force, it gave a "D" to "screening with resting electrocardiogram, exercise treadmill test or electron beam CT scanning for coronary calcium, for either the presence of severe coronary artery stenosis or the prediction of coronary heart disease events in adults at low risk for CHD events."
Even for adults at increased risk for CHD events, the task force "found insufficient evidence (an "I" grade) to recommend for or against routine screening with EKG, treadmill testing, or EBCT scanning for coronary calcium, for either the presence of severe coronary artery disease or the prediction of CHD events."