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Jul 30, 2013

Echocardiograms Unnecessary for the General Population

Study finds that a useful heart test has negligible benefit for healthy patients without a family history of heart disease.

Although it’s rare, healthy individuals can sometimes have heart disease and not know it. When patients with low cardiovascular risk and no family history of heart disease actually have heart disease but show no symptoms, it can be especially dangerous because they are less likely to be diagnosed and receive life-saving treatment. And by the time the heart disease is finally recognized, it may be too late.

Fortunately, there’s a painless test called an echocardiogram that can detect heart disease in these types of patients by using sound waves to take moving pictures of the heart. Unlike other tests, there’s no radiation involved and echocardiograms can provide useful information needed to diagnose heart disease. So experts have wondered whether all adults should undergo this test to help identify those few patients that don’t show any symptoms but have heart disease. According to a study published in the Journal of the American Medical Association, this type of widespread screening in healthy adults does not help improve health outcomes for patients.

This study included more than 6,800 middle-aged Norwegian patients who were free from heart disease at the start of the study. Roughly half of participants were randomly chosen to receive echocardiograms and researchers tracked the health of all participants over the course of 15 years through surveys and physical exams. Although the echocardiogram helped diagnose slightly more heart conditions in participants (nearly 9% compared to 8% in the group that didn’t receive the test), there was no significant difference in survival rates, heart attack or stroke between the two groups. After 15 years of follow-up, about 27% people in each group died; this is similar to the mortality rate expected in the general Norwegian population.

Based on these findings, experts conclude that screening the general population with echocardiograms is not beneficial for healthy patients with no symptoms of heart disease. Patients receiving the test in this study did not live any longer or have fewer cardiovascular events than those not receiving the test, and experts think that they know why. First, it’s rare that patients without symptoms actually have heart disease so screening all adults is like looking for a needle in a haystack. Second, screening and early diagnosis is only useful if treatment can help slow or stop the progression of the disease, improving outcomes. In this case, screening is most effective when focusing on those with a family history of heart disease because they are more likely to have heart issues. So when researchers looked only at individuals in the study who had a family history of heart attack, the screening did help reduce risk of death after by 15 years by nearly 5%.

These findings highlight how important it is that patients with a family history talk with their doctor about monitoring their health closely and reducing their heart disease risk. There’s a wealth of resources available that can help diagnose, treat and even prevent heart disease for many individuals and taking these steps can help us live longer, healthier lives.

Questions for You to Consider

  • What is an echocardiogram?
  • An echocardiogram (also called an echo) is a type of ultrasound test that uses high-pitched sound waves that are sent through a device called a transducer. The device picks up echoes of the sound waves as they bounce off the different parts of your heart. These echoes are turned into moving pictures of your heart that can be seen on a video screen and help the doctor learn more about your heart.
  • How does family history impact my risk for heart disease?
  • There are some risk factors for heart disease that we can control, such as high blood pressure and high cholesterol, and some that we can’t, including family history. Individuals with a family history of heart disease have a naturally predisposed risk and are more likely to develop heart disease than those without a family history. Patients with a family history of heart disease should talk with their healthcare provider to discuss monitoring heart health and addressing any risk factors that they can change.

Featured Video

This video tells you everything you need to know about having an echocardiogram.

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