A "screening" EKG

Companies are trying to take advantage of the pro-screening bias in the public. Charging patients for a “screening” EKG is pretty close to fraud, as an EKG by itself is pretty insensitive for many heart diseases:

In early June, Rae Ann Jacek, president of a parent teacher organization in Chelmsford, Mass., and a member of the town’s school board, plunked down almost $300 for heart tests for her three children ““ 13, 16, 18 ““ her husband, and herself.

Jacek was one of about 100 town residents, including 2,200 children in the school district, and among a growing number of people across the region who are using the services of Andover, Mass., company, HeartScreen America, to reassure themselves that they and their loved ones don’t run the risk of a sudden cardiac arrest.

For Jacek and the members of her family, the results were normal ““ a report the parent and school official said was well worth its price. The company charged $49 for adolescent screenings and $69 for adult heart screenings.

But many question the value of private sector screenings, including Dr. Natacha Sochat, medical director for the Nashua public health department.

“An EKG by itself can give a false sense of security,” Sochat said during a telephone interview, adding that only “a small number of kids” have problems that can be detected with the test.

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  • The Independent Urologist

    For this type of thing, which is obviously worthless, let the buyer be ware. This family could have saved some money by going to their doctor and asking about it. But purchases like this are emotional, not rational.

  • Anonymous

    It seems to me they are misleading for everyone involved. You go to the ER and get a good EKG and easily the Doc. is misled into believing you are fine and hands you a PPI and sends you on your way. So, it is not just patients that are misled by EKGs. Why are they still being used as diagnostic, when in fact they may actually be causing delayed diagnoses?

  • Evan

    They are diagnostic. They just aren’t diagnostic of the things people worry about. If you are having heart attack at the moment of the test, your abnormal EKG is a critical piece of information that is integral to the diagnosis. If you have WPW, the only way you’ll find out about it is an ECG. They also show many other rhythm anomalies, and are thus a critical part of the evaluation.

    What they don’t show is any evidence of the presence or absence of coronary artery disease, with the exception of old infarctions.

    However the amount of value in appropriate clinical settings with interpretation given to the patient is about as good as any single test I can think of, certainly at least as important as a CBC, which would also be a crappy screening test.

  • Anonymous

    Of course they are diagnostic.
    But back to sensitivity, specificity, and predictive values.
    sensitivity, does it find what you’re looking for
    specificity, does the finding mean only one thing, or a bunch of possible things
    predictive value, how much does it add to the clinical picture to have the test’s answer. Does a normal (negative) EKG mean you won’t drop dead this afternoon? nope, you might drop dead of something it is poor at detecting, like a critical LAD with a plaque about to rupture. Unfortunately a positive EKG isn’t much help either by itself. If you’re young and healthy but have a little ST segment elevation it is probably just how you repolarize (being young, healthy, and with good vagal tone). Has such an EKG finding helped the worried well? not so much, as the doc now has to reccomend further testing ($, time, risk).

    If the American College of Cardiologists thought there was any value in routine EKG screening don’t you think they would have cashed in on this like GI docs and colonoscopy?

  • retired doc

    I no longer have the reference, but I did see an article in a medical journal that EKG’s could pick up evidence of the hypertrophic septal cardiomyopathy that presents in kids as sudden death during exercise. This is far from my specialty, but it would seem this might be worth adding to an athletic physical? Anyone out there more expert than me on this subject? (wouldn’t be hard (:)

  • Happyman

    from “UpToDate”, the bible of current medical standard of care, as far as I’m concerned:

    “In the United States, cardiac ultrasound, electrocardiography, and graded exercise testing are not recommended as routine screening methods for detection of cardiovascular disease in large groups of athletes as part of the PSE “

  • Mike

    This misguided mother probably wanted ECHocardiograms for her kids. It would help detect IHSS, which is what I figure she was worried about. However, the ACC still hasnt come out and made a blanket recommendation for them in student athletes. However, they probably should.

  • Vijay Goel, M.D.

    Its interesting in a world where people think they pay $20 for a doctor’s visit, that they’re willing to fork out hundreds of dollars for a clinically useless diagnostic exam.

    Seems to me that people actually are willing to pay for healthcare, but lack the resources to really understand where they’re getting value.

    Its also interesting that the urologist thinks the family could have saved money by going to the doctor…how much do you think that doctor visit would have cost in both time and money?

  • Michael Rack, MD

    “If the American College of Cardiologists thought there was any value in routine EKG screening don’t you think they would have cashed in on this like GI docs and colonoscopy?”
    EKG’s aren’t big moneymakers. The reimbursement is about $35. Not much, considering than an EKG machine costs about $3000, and considering the time it takes for a tech/nurse to perform an EKG. I decided against getting an EKG for my practice, and just send patients to the local hospital’s outpatient lab when they need an EKG.

  • Takeittoheart.org

    With all due respect, statements such as those made by Kevin, MD, “Companies are trying to take advantage of the pro-screening bias in the public. Charging patients for a “screening” EKG is pretty close to fraud,” are readily perpetuating more apathy in the public and medical communities, and are potentially leading to the sudden cardiac death of thousands more young people each year from unidentified heart problems. Most likely, many of those heart problems could be detected with a simple electrocardiogram read by a cardiologist. Nothing is 100% – neither mammograms, x- rays, blood pressure screenings, nor most tests that are used to screen any health problems… They are all just that… screenings… a chance for early detection!

    Approximately 85% of the heart problems that can cause sudden cardiac death in young people are identifiable on an electrocardiogram, according to experts. The issue is not that sudden cardiac death in young people is so rare… the issue is that it is under reported; we do need to worry, and we do need to do something! Innocent children are dying from undetected heart problems that, by and large, can be detected and treated! With treatment, these young people can live long, healthy, and productive lives!

    I know personally, because my beloved 15 year old seemingly healthy and athletic daughter, died in her sleep of a cardiac arrest from undetected Long QT Syndrome, a potentially detectable and treatable electrical heart problem. We had NO family history of such. Her death could have been prevented had an electrocardiogram been done and read by a pediatric cardiologist and her heart problem then treated. We have since discovered 2 teenage cousins in the family who also have LQTS and they are now being treated with medication.

    The loss of a child is an insurmountable pain that scars a parent forever! If you have children, you can perhaps imagine the pain… intensified more so, by knowing that your child’s death could have been prevented! By not screening children’s hearts for electrical and structural problems, we are declaring that their young lives are not worth saving and, in essence, we are handing thousands of children every year a death sentence. Why neglect a population of innocent young people with heart problems? To what other segment of the population do we ignore deadly medical concerns this way??? Is it because young people do not have the power to speak out for themselves that they can be ignored like this?

    We, parents, are being told by our pediatricians that our children are healthy… but, no one can tell if a heart is healthy just by listening with a stethoscope! Electrical problems cannot be heard with a stethoscope, and cardiomyopathies, the number one cause of sudden cardiac death in young people in the U.S, cannot be heard with just a stethoscope!

    In 2003, I founded Take It To Heart, http://www.TakeItToHeart.org, a program designed to help prevent sudden cardiac death in young people. We provide educational programs and heart screenings which include an electrocardiogram read by a cardiologist. We have been very successful in identifying previously undetected heart problems in young people that could have otherwise, if left undetected, potentially led to tragic circumstances.

    I am also a member of Parent Heart Watch, http://www.parentheartwatch.org, a national organization of parents across the country who have lost a child to sudden cardiac arrest or who have an at-risk child. We are all working very hard to help prevent sudden cardiac death in all young people. There is no national data bank collecting data on the number of young people who die each year from cardiac arrest and, unfortunately, it is not recognized for the national crisis that it is! Thousands of seemingly healthy young people are dying every year in the U.S. from unidentified heart problems. The Heart Rhythm Society estimates that 14,000 young people die every year from sudden cardiac arrest!

    Please review this issue carefully before publishing statements that will help perpetuate this travesty in our medical system! Children need their hearts screened with an electrocardiogram which is over-read by a cardiologist. Parents deserve the right to be educated on this issue and to realize that they have an option to take preventive measures. Not to do so is playing Russian roulette with children’s lives! Do you really know if your child’s heart is healthy? Isn’t your child’s life worth a price of less than $50.00? I know that all of us parents who have lost a child to sudden cardiac arrest would have gladly paid anything to know what we now know. An inexpensive, simple, painless, non-invasive ECG read by a cardiologist is a very small price to pay for the enormous amount of knowledge gained!!!

    As the saying goes, “If you’re not part of the solution, then you’re part of the problem!” I am personally very grateful that HeartScreen America exists! They are performing an extremely valuable service for our children and their potential to save young lives has been grossly underestimated! Our kids need us to look out for their well-being. If we don’t look out for them, who will?

    Rhonda L. Foster, R.N.
    Communication Chair,
    Parent Heart Watch
    A National Voice Protecting Kids from Sudden Cardiac Arrest

    Founder and Project Director
    Take It To Heart; A Project of the Foundation for Enhancing Communities
    Take It To Heart is an affiliate of Parent Heart Watch

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