Recently, we've gotten a number of patients wondering why they do not get an EKG at their annual physical appointments. Similar questions arise about labs during these visits. In the past, there was thought among the medical community that checking these labs (cholesterol, blood counts, kidney function, urine, etc) and getting an EKG annually were "helpful" in determining the overall health of a patient. While labs are a little more confusing and very patient specific, let's take a closer look at the current recommendations for screening EKGs (specific symptoms should always prompt an EKG, but in such cases it is no longer a screening test which is why we make the distinction):
The U.S. Preventative Services Task Force (USPSTF) recommends against screening EKGs in low risk patients. The evidence currently shows that the risks of screening (false readings, misdiagnoses, further interventional workup and unneeded treatment) outweigh the benefits. For intermediate or high risk patients, the USPSTF and other organizations note that there is insufficient evidence to assess the balance of risks and benefits. Basically, there is no clear winner between risks and benefits and they may be about even. So what decides a persons' risk?:
- blood pressure
- other medical problems
- smoking status, etc
To summarize: there are specific conditions and symptoms that warrant an EKG. However, there are very few indications for a typical screening EKG, and even when done, the evidence from a risks/benefits perspective is lacking. So feel free to ask your doctor, discuss your risk factors, help calculate your overall risk and make an informed decision with guidance from us... but the era of yearly EKGs at annual checkups is over!
Lauren Hedde, DO and Mark Turshen, MD are Family Physicians and Founders of Direct Doctors, Inc. a Direct Primary Care Practice.