Screening for coronary artery disease in assymptomatic adults is not recommended, so why is it still done?
The rationale behind screening for asymptomatic coronary artery disease is that it may diagnose advanced disease that, while frequently without symptoms, may present for the first time as sudden death. Identifying significant coronary artery disease would enable intervention against risk factors and, if necessary, preventive revascularization. The most recent evidence shows that screening for coronary artery disease with resting electrocardiogram, exercise tolerance testing or electron-beam computerized tomography in low-risk patients does more harm than good, and should not be performed. This negative recommendation is based on the fact that the use of the aforementioned tests has a negative benefit-harm ratio, because the false-positive rate cancels out any benefit from the occasional detection of real disease, inducing a cascade of further testing (sometimes with angiography) and overdiagnosis of a disease that is not in fact present, with negative psychological and financial consequences, such as increased insurance premiums. We feel that the Portuguese Society of Cardiology should intervene with the institutions performing screening of coronary heart disease in asymptomatic patients, and recommend abandoning a practice that is of little use and, overall, harmful.
Carneiro
Antonio Vaz
AV
Centro de Estudos de Medicina Baseada na Evidência Faculdade de Medicina de Lisboa, Lisboa, Portugal. avc@fm.ul.pt
D000328:Adult; D003324:Coronary Artery Disease / Q000175:diagnosis*; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*