Low-risk patients opt for annual ECGs—despite clinical recommendations

Despite many physicians’ reticence to recommend annual electrocardiograms as part of a yearly physical, a study conducted in Canada proved that more than one in five annual health exams lead to one.

Lead researcher R. Sacha Bhatia and co-authors conducted the population-based cohort study retrospectively, evaluating results of 3,629,859 low-risk adults’ physician visits between 2010 and 2015, before publishing their findings in the Journal of the American Medical Association. Out of the more than 3.5 million people studied, all had at least one physical exam in those five years and none had any previous cardiac issues.

Bhatia and colleagues found a large portion—21.5 percent—of their study population was recommended for additional screening, including an ECG, within 30 days of their appointment. The numbers varied across 679 primary care practices; at those practices, physicians ordered ECGs for between 1.8 percent to 76.1 percent of their patients. The range stretched even wider for the 8,036 primary care physicians represented; ECGs were recommended for between 1.1 percent and 94.9 percent of those patient pools.

Those who did submit to an ECG were five times more likely to receive additional downstream cardiac testing and consultations, Bhatia et al. found, which eventually led to secondary outcomes like hospitalization, revascularization a year later and, in some cases, death.

Bhatia explains in the study that clinical guidelines advise against routine ECGs in asymptomatic patients, but the actual impact of an ECG on a low-risk individual, and the frequency with which they’re ordered, is unknown. Routine ECGs, the study's authors found, increased the chances of further cardiology testing and consultations. Still, in this relatively healthy population, Bhatia found the risks for heart disease and the cardiac event rate were ultimately “very low."