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June 12, 2018

The Screening ECG and Cardiac Risks

Author Affiliations
  • 1Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida
JAMA. 2018;319(22):2277-2279. doi:10.1001/jama.2018.6766

The initial target of clinical electrocardiography was the characterization of arrhythmias and conduction disturbances, followed by the recognition of the value of 12-lead electrocardiograms (ECGs) in diagnosing and tracking the progression of acute ischemic events. Resting and exercise electrocardiography then expanded into the realm of identification and risk stratification of patients with known or suspected coronary heart disease, based on prior events or symptoms.

Resting and exercise ECGs were subsequently used to screen asymptomatic individuals for the presence of unsuspected disease. Although precise data are not available, resting and exercise ECG examinations of asymptomatic patients became commonplace as part of routine annual examinations until a series of analyses led multiple professional societies to recommend against such practice. In parallel with this, recognition of risk factors for atherosclerotic disease became more sophisticated, and risk-scoring profiles capable of classifying high-, intermediate-, and low-risk subgroups were developed over time.1 However, the power of individual risk prediction remained limited, and there was motivation to reevaluate the screening ECG question because of the population burden of cardiovascular disease.