Echocardiographic screening does not improve all-cause mortality

Image: PD 

1. No mortality benefit was observed among white Norwegian adults randomly selected for echocardiographic screening for structural heart disease. 

2. No difference was observed in sudden death, death from cardiovascular disease, myocardial infarction or stroke. 

Evidence Rating Level: 1 (Excellent) 

Study Rundown: Echocardiography is a non-invasive, low-risk procedure with high sensitivity for detecting structural heart disease.  This study aims to evaluate the efficacy of echocardiographic screening of asymptomatic middle-aged adults with the goal of reducing all-cause mortality at 15-year follow-up. A total of 7.6% of patients were identified as having pathologic structural heart disease. However, there were no differences observed in all-cause mortality, sudden death, death from cardiovascular disease, myocardial infarction or stroke between the screened and control study group. Based on these data, the adoption of universal echocardiographic screening among middle-aged patients provides no survival benefit.  A large homogenous population limits the study, as all participants are white Norwegians. Also, it does not include data on the efficacy of screening in patients who may be identified as having a higher incidence of structural heart disease, such as those identified through abnormal cardiac auscultation.

Click to read the study in JAMA Internal Medicine

Relevant Reading: ACC/AHA Guidelines for the Clinical Application of Echocardiography

In-Depth [randomized controlled trial]: This study included 6861 white middle-aged Norwegians who are participants in the Tromso study group.  Patients were randomized to either screening or control groups, and followed for a period of 15 years. Of 290 (8.9%) patients in the echocardiographic screening group who identified for follow-up, 249 (7.6%) were confirmed to have pathologic cardiac or valvular conditions. Despite this, all-cause mortality at 15 years did not differ between the screened (26.9%) and control (27.6%) group populations (hazard ratio, 0.97; 95% CI, 0.89-1.06).  Similarly, there were no differences observed among secondary outcome measures of sudden death (hazard ratio, 0.97; 95% CI, 0.51-1.87), death from heart disease (hazard ratio, 0.97; 95% CI, 0.77-1.08), myocardial infarction (hazard ratio, 0.95; 95% CI, 0.83-1.08), and stroke (hazard ratio, 1.02; 95% CI, 0.87-1.19).

By Evan Shalen and Brittany Hasty 

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