Screening for Coronary Heart Disease

U.S. Preventive Services Task Force

Release Date: February 2004

Summary of Recommendations / Supporting Documents

Summary of Recommendations

• The U.S. Preventive Services Task Force (USPSTF) recommends against routine screening with resting electrocardiography (ECG), exercise treadmill test (ETT), or electron-beam computerized tomography (EBCT) scanning for coronary calcium for either the presence of severe coronary artery stenosis (CAS) or the prediction of coronary heart disease (CHD) events in adults at low risk for CHD events.

  Rating: "D" recommendation.

  Rationale: The USPSTF found at least fair evidence that ECG or ETT can detect some asymptomatic adults at increased risk for CHD events independent of conventional CHD risk factors (go to Clinical Considerations), and that ETT can detect severe CAS in a small number of asymptomatic adults. Similar evidence for EBCT is limited. In the absence of evidence that such detection by ECG, ETT, or EBCT among adults at low risk for CHD events ultimately results in improved health outcomes, and because false-positive tests are likely to cause harm, including unnecessary invasive procedures, over-treatment, and labeling, the USPSTF concluded that the potential harms of routine screening for CHD in this population exceed the potential benefits.

• The USPSTF found insufficient evidence to recommend for or against routine screening with ECG, ETT, or EBCT scanning for coronary calcium for either the presence of severe CAS or the prediction of CHD events in adults at increased risk for CHD events.

  Rating: "I" recommendation.

  Rationale: The USPSTF found inadequate evidence to determine the extent to which the added detection offered by ECG, ETT, or EBCT (beyond that obtained by ascertainment of conventional CHD risk factors; go to Clinical Considerations) would result in interventions that lead to improved CHD-related health outcomes among adults at increased risk for CHD events. Although there is limited evidence to determine the magnitude of harms from screening this population, harms from false-positive tests (i.e., unnecessary invasive procedures, over-treatment, and labeling) are likely to occur. As a result, the USPSTF could not determine the balance between benefits and harms of screening this population for CHD.

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Supporting Documents

Screening for Coronary Heart Disease, February 2004
Recommendation Statement (PDF File, 80 KB; PDF Help)
Summary of the Evidence (PDF File, 245 KB; PDF Help)
Systematic Evidence Review PDF File, 2 MB; PDF Help)
Video: How to Talk with Your Patients When Evidence Is Insufficient (3:20 minutes, Windows Media®)

Note: If you cannot see the captioning in Windows Media® Player, press "CTRL + SHIFT + C" (or select: Play > Captions and Subtitles > Captions).

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Current as of February 2004

Internet Citation:

Screening for Coronary Heart Disease, Topic Page. February 2004. U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf/uspsacad.htm