Paula Rutledge
Executive Medical Device Recruiter | 30 Years Medical Device | Executive Headhunter |
June 2018
< 1 min reading time
Wow. The CDC says that 1 in 4 people will die of heart disease. 610,000 people in the U.S. alone. As someone who lost a friend very young to undiagnosed heart disease, this shocks and disturbs me. For a relatively low cost burden, the ECG is a simple, non-invasive test that saves lives.Moreover, more sensitive and predictive ECG and EKGs are on the way, including an exciting technology from HeartSciences, currently approved in several regions, but not yet in the U.S. “HeartSciences’ MyoVista® Wavelet ECG Device is breakthrough technology in electrocardiography designed to assist in the early detection of heart disease*. MyoVista wavECG Technology is focused on closing the diagnostic gap related to identifying patients having an elevated risk of a cardiac adverse event. Patented signal processing methods using wavelet mathematics provide new information related to energy in the acquired ECG signal. As for me and my family, I don’t want to waste my -or taxpayer money. But a simple, inexpensive ECG or EKG that provides early diagnosis makes sense.  Doctors Told Not to Order ECG’s for Low-Risk PatientsDoctors shouldn’t routinely perform electrocardiograms on patients at low risk for heart disease, an influential federal panel is recommending. While an ECG test of the heart’s electrical activity is safe and inexpensive, the benefits for patients at… source: https://www.linkedin.com/groups/78665/78665-6413403128753909763 Marked as spam
 Posted by Asked on June 15, 2018 12:00 am
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Julie Omohundro
This isn't anything new. This has been the recommendation of the same task force, the American Academy of Family Physicians, the American College of Cardiology Foundation, and the American Heart Association for a number of years now.
It seems very unlikely than routine ECGs/EKGs would provide early diagnosis in low-risk patients, while a false positive result could lead to invasive follow-up procedures, which always carry some risk. This is what they mean when they say that the benefits don't outweigh the risks. http://www.choosingwisely.org/patient-resources/ekgs-and-exercise-stress-tests/ Marked as spam
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Fareed Iqbal
I don't think it's possible to have a false positive EKG. If it's being performed for rhythm analysis it's either normal or abnormal. I agree with Paula. For such an inexpensive test I can't see the financial gain in excluding its use. If it's being performed for ischemia then perhaps it's utility is questionable. But what do I know?
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I cuncur with Julie.
And it is not that a significant amount of the 610k deaths stem from the low risk patients. Low cost procedures on a lot of people adds up to significant healthcare costs which could be spent more efficiently. And Fareeq: a lot of tests will likely be inconclusive leading to other more expensive tests and stress for the (non)patients. Marked as spam
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Julie Omohundro
Fareeq, I'm not enough of an EKG expert to speak to the technical outcome, but if the results of a test indicate that further procedures, diagnostic or therapeutic, are needed, when there is really nothing clinically amiss with the patient, the end result from the patient's perspective is the same...much ado about nothing. Perhaps I should have called it a "false alarm" instead.
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I would like to add my thoughts as a cardiologist. I agree with the recommendation of NOT performing a ROUTINE ECG in a LOW RISK patient. That only increases healthcare costs (when the money is not available) and just enriches the doctor. And after all that, the patient has no benefit! Besides, nothing in medicine should be 'routine'. If a low risk patient presents with chest pain, they should and will get an EKG. If you are an asymptomatic 30 year old with no cardiovascular risk factors (hypertension, diabetes, smoking, high cholesterol, obesity, first degree relatives with early onset heart disease, etc) who just goes to the doctor for an annual physical which turns out to be normal (normal labs, normal blood pressure, normal physical examination and no murmurs), an EKG is completely useless. And yes, an EKG can be falsely positive in some situations that will drive many primary care doctors to perform more expensive testing such as an Echocardiogram or an unnecessary stress test
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Marc Fuller
If you read the article, not the headline, this makes perfect sense. What it says is the invasive procedures that follow an EKG that is false positive put the patient at risk. Based on statistics the conclusion is that an EKG on these low risks patients will result in causing more problems than solving others. If you have ever worked in a cath lab, you realize that these procedures are not risk free and as for any other medical procedure the risk to reward ratio needs to be understood. This is not an advisory based on economics, but patient outcome.
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Fareed Iqbal
Peter Angelopoulos-Yes, agree for LOW RISK patients no real clinical need. Though I don't think it will stop people requesting one during a health screen. I was (and am) fit and healthy, I had a routine ECG in 2009 which showed a RBBB and after what may be perceived as an 'unnecessary' echo I was diagnosed with an ASD-all fixed now. I was a low-risk asymptomatic patient as you describe. But maybe I just have bias from my own experiences.
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Paula Rutledge
What an broad spectrum of opinions. Fareed, your story is part of why it seems to make sense to do an EKG on most patients to a non-clinical person like myself.
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Caron D'Ambruso
We need EKG to save lives for asymptomatic patients and it’s a lot less expensive to do an EKG than letting heart disease go unnoticed and ending up with a much more expensive procedure or loss of life down the road.
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Mark C Adams, MBA
EKG are low cost, well established routine screenings.
Why not? We read all the time about young athletes dying of sudden cardiac death because they were assumed to be healthy. Marked as spam
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Julie Omohundro
Dr. Angelopoulos, I will add that "routine" medical procedures don't just enrich the physician, but also the shareholders of companies involved in the development, manufacture, marketing and distribution of EKG technologies. In addition, it is much easier to part investors from their money if you can tell them that healthcare providers will routinely use the product they are being asked to invest in without any consideration as whether it is likely to provide their patients with any benefit.
But that's not what "routine" normally means in a clinical context, where "routine" procedures are adopted based on recommendations by entities such as this task force, because the clinical value of the procedure is well supported by data. When doctors "routinely" perform procedures that are not well-supported by data, or go against such recommendations, that's something else entirely. Marked as spam
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Julie Omohundro
I must say I’m doubtful that this is much of an issue in the US. Most GPs are now employees of corporations and the procedures are usually paid for by third parties. I should think that both types of entities keep far too close an eye on their bottom line to tolerate the use of “routine” EKGs in low-risk patients. The corporations also keep a tight lid on their legal risks, so that they also would not want to run even the rare risk of a patient being harmed in follow-up procedure based on the results of a procedure for which there was no scientific justification for doing in the first place.
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Julie Omohundro
Mark, the main point of the recommendation against the use of EKGs in low-risk patients is that they are NOT well-established as clinically useful in this population. "Low cost" is in the wallet of the payee. If patients want to pay for these procedures themselves, rather than use those same dollars to pay for something that has been shown to have clinical benefit, then I aggressively support their right to do so. Especially the ones who are too young to have had a chance to reproduce yet.
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Having worked in heart surgery, cath labs,ECMO, extracorporeal life support, transplants, IAB support and a lengthy list of others, I will attest a knowable cardiac diagnostician can discern most everything from a properly conducted ECG:EKG. It is simple yet needs accurate application and diagnostic analysis. Subtle changes on waveforms from different vectors can tell so much.
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