ECG-based cardiac screening programs: Legal, ethical, and logistical considerations

ECG-based cardiac screening programs: Legal, ethical, and logistical considerations.

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Item Type: Article
Status: Published
Official URL:
Journal or Publication Title: Heart Rhythm
Volume: 16
Number: 10
Page Range: pp. 1584-1591
Date: 2019
Divisions: Molecular Cardiology
Depositing User: General Admin
Identification Number: 10.1016/j.hrthm.2019.03.025
ISSN: 15475271
Date Deposited: 04 Jan 2021 23:51

Screening asymptomatic people with a resting electrocardiogram (ECG) has been theorized to detect latent cardiovascular disease. However, resting ECG screening is not recommended for numerous populations, such as asymptomatic middle-aged (sedentary) people, as it is not sufficiently sensitive to detect coronary artery disease. While the issues raised in this article are largely common to all screening programs, this review focuses on 2 distinct programs: (1) screening elite athletes for conditions associated with sudden cardiac death (SCD); and (2) screening people aged ≥65 years for atrial fibrillation (AF). These 2 settings have recently gained attention for their promise and concerns regarding prevention of SCD and stroke, respectively. If screening is to be done, it must be done well. Organizations conducting screening must consider a range of legal, ethical, and logistical responsibilities that arise from the beginning to the end of the process. This includes consideration of who to screen, timing of screening, whether screening is mandatory, consent issues, and auditing systems to ensure quality control. Good infrastructure for interpretation of ECG results according to expert guidelines and follow-up testing for abnormal screening results, including a pathway to treatment, are essential. Finally, there may be significant implications for those diagnosed with cardiac disease, including insurance, employment, the ability to play sport, and mental health issues. There are several legal risks, and the best protective measures are good communication systems, thorough clinical record-keeping, careful handling of eligibility questions for those diagnosed, and reference to expert guidelines as the standard of care.

Orchard, Jessica J.
Neubeck, Lis
Orchard, John W.
Puranik, Rajesh
Raju, Hariharan
Freedman, Ben
La Gerche, Andre
Semsarian, Christopher
Last Modified: 04 Jan 2021 23:51

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