Screening echocardiograms not beneficial

Clinical Question

Does screening for heart disease with echocardiography decrease mortality, myocardial infarction risk, or stroke risk?

Bottom Line

Population-based screening for heart disease or valve disease with echocardiography will identify cardiac pathology in patients but does not decrease mortality, myocardial infarction risk, or stroke risk. (LOE = 1b)

Reference

Lindekleiv H, Løchen ML, Mathiesen EB, Njølstad I, Wilsgaard T, Schirmer H. Echocardiographic screening of the general population and long-term survival. A randomized clinical study. JAMA Intern Med 2013;173(17):1592-1598.

Study Design: Randomized controlled trial (non-blinded)
Funding: Unknown/not stated
Setting: Population-based
Allocation: Uncertain

Synopsis

In 1994 and 1995 Norwegian researchers enrolled 6861 middle-aged (average age = 60 years) inhabitants of a single city (Tromsø). The participants were randomly assigned, concealed allocation unknown, to a one-time screening for heart disease using 2-dimensional echocardiography or to no screening. The screening and control groups were both all white and evenly split by gender. Approximately 12% of patients self-reported coronary heart disease, 59% had hypertension (though only 13.5% were treated with medication), 32% smoked, and only 4% had diabetes. Screening identified 7.6% of patients with cardiac or valvular conditions and were treated. Over 15 years of follow-up, 26.9% of the participants in the screening group died as compared with 27.6% in the control group (N.S.). Similarly, there was no effect of screening on rates of sudden death, mortality from heart disease, or incidence of fatal and nonfatal myocardial infarction and stroke.

Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA

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