Echo screening: No benefit for general population

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Screening the general population with echocardiography to detect structural and valvular heart disease does not lower the risk of dying or having a heart attack or stroke, according to a population-based study from Norway.

Researchers led by Haakkon Lindekleiv, MD, of the University of Tromso, gathered data from 6,861 participants enrolled in the Tromso Study. The Tromso Study began in 1974 and utilizes repeated surveys of different population cohorts to assess mortality from cardiovascular disease. Their study was published online July 22 in JAMA Internal Medicine.

Lindekleiv and his colleagues used a fourth survey and randomly assigned participants to receive either echocardiographic screening or no screening.

During 15 follow-up years, there were no statistically significant differences between the two groups in death or incidence of stroke and heart attacks—26.9 percent of the screening group and 27.6 percent of the control group died. Controlling potential confounding variables had no impact on the results.

Around 8 percent of the screening group had existing structural heart and valvular disease, with valvular being most common, but diagnosing asymptomatic disease offered little benefit.

“Although sclerosis of the aortic and mitral valves has been associated with a substantial increased risk of cardiovascular disease, we did not find that early diagnosis of valvular disease in the general population translated into reduced risk of death or cardiovascular events,” the authors wrote.

Screening also did not lower all-cause mortality among people with risk factors, such as hypertension, diabetes or a 10-year risk of fatal cardiovascular disease.

The researchers argued their study is still valuable, despite the findings.

“Although our results were negative, we believe that they are of clinical importance because they may contribute to reducing the overuse of echocardiography,” they wrote. Even though the test is noninvasive, additional workup due to abnormalities can cause patients to experience undue stress and expense.

They also found that screening reduced all-cause mortality risk in participants with a family history of early MI by 4.7 percent, but they warned that this reduction could have happened by chance. However, they proposed that the association warrants additional follow-up.

In an accompanying editorial, Erin D. Michos, MD, and Theodore P. Abraham, MD, of Johns Hopkins University School of Medicine in Baltimore, noted that the findings support the American Society of Echocardiography’s Appropriate Use Criteria (AUC).

According to those guidelines, routine testing without a change in clinical status or when results are not likely to change patient management is considered mostly likely to be inappropriate.

Distinguishing between testing and screening is critical, and additional training could also help, Michos and Abraham argued.

“Educational interventions based on the AUC may help reduce inappropriate use of echocardiography,” they wrote.