Perspective:

The U.S. Preventive Services Task Force has recommended against routine ECGs in people at low risk. Although the test is considered harmless, the rationale is that it can trigger a subsequent set of largely unneeded tests, some dangerous, with no proven clear benefit in this population. Nonetheless, routine ECGs are done frequently in many offices and during many periodic physicals. In this study, a working age population in Japan was evaluated, as their ECGs were largely done in a routine fashion as part of an annual employment physical. Indeed, the presence of even minor ECG abnormalities was associated with increased overall cardiovascular risk, and the presence of abnormalities suggested that there would be more abnormalities in the future.

But does the knowledge of these abnormalities drive actions that will improve outcome? Or, perhaps, will the knowledge of these abnormalities in this asymptomatic group just result in more tests that will do nothing more than worry the patient, spend money, and even confer harm? Well, that will be the next question to answer. This trial, however, does provide important information that suggests there may be value in routine ECGs in low-risk subjects, as it identifies abnormalities that can be addressed. Perhaps addressing the minor abnormalities may be simply a motivation for intensified blood pressure and lipid management. And perhaps detecting the patients with major abnormalities may be enough to drive an improved overall outcome.

At this time, however, the question is really whether routine ECGs in low-risk patients has value. This study leaves us with a firm “maybe” followed by a call to investigate how these findings were managed, and whether that management led to improved outcomes. Strategies would need to be developed on how to handle major and minor abnormalities.