Abstract
BackgroundRoutine electrocardiograms (ECGs) are not recommended for asymptomatic patients because the potential harms are thought to outweigh any benefits. Assessment tools to identify high risk individuals may improve the harm versus benefit profile of screening ECGs. In particular, people with unrecognized myocardial infarction (UMI) have elevated risk for cardiovascular events and death.MethodsUsing logistic regression, we developed a basic assessment tool among 16,653 participants in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study using demographics, self-reported medical history, blood pressure, and body mass index and an expanded assessment tool using information on 51 potential variables. UMI was defined as electrocardiogram evidence of myocardial infarction without a self-reported history (n = 740).ResultsThe basic assessment tool had a c-statistic of 0.638 (95% confidence interval 0.617 - 0.659) and included age, race, smoking status, body mass index, systolic blood pressure, and self-reported history of transient ischemic attack, deep vein thrombosis, falls, diabetes, and hypertension. A predicted probability of UMI > 3% provided a sensitivity of 80% and a specificity of 30%. The expanded assessment tool had a c-statistic of 0.654 (95% confidence interval 0.634-0.674). Because of the poor performance of these assessment tools, external validation was not pursued.ConclusionsDespite examining a large number of potential correlates of UMI, the assessment tools did not provide a high level of discrimination. These data suggest defining groups with high prevalence of UMI for targeted screening will be difficult.
Highlights
Routine electrocardiograms (ECGs) are not recommended for asymptomatic patients because the potential harms are thought to outweigh any benefits
Characteristics of the REGARDS study population considered for the basic assessment tool are presented in Table 1 by unrecognized myocardial infarction (UMI) status
Basic assessment tool Established Myocardial infarction (MI) risk factors such as age, male sex, cigarette smoking, diabetes, and hypertension were associated with UMI in unadjusted analyses (Table 2)
Summary
Routine electrocardiograms (ECGs) are not recommended for asymptomatic patients because the potential harms are thought to outweigh any benefits. Assessment tools to identify high risk individuals may improve the harm versus benefit profile of screening ECGs. In particular, people with unrecognized myocardial infarction (UMI) have elevated risk for cardiovascular events and death. Electrocardiogram (ECG) screening may identify previously unrecognized, treatable cardiac problems, such as unrecognized myocardial infarction (UMI), thereby improving health, but could expose patients to sideeffects of treatment and lead to further testing with associated costs and risks. Avoiding screening ECGs for low for UMI which could be used to identify populations where ECG screening may be warranted
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