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Be wary of commercial cardiovascular screening services

Screening tests for heart disease, stroke, and other diseases have a lot of intuitive appeal. Of course it is better to catch a disease in an earlier, more treatable stage and prevent a potentially fatal event. If only it were that simple. Screening tests are never 100% accurate, so they can lead to false positives—results that suggest that a disease might be present, but follow-up tests show that it isn't. That additional testing may add cost and stress, and in some cases, cause harm. On the flip side are worrisome false negatives—when the tests fail to detect a disease that is present.

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  Asymptomatic Carotid Artery Stenosis: Screening - Final Recommendation Statement

The USPSTF recommends against screening for asymptomatic carotid artery stenosis in the general adult population. The final recommendation mirrors a draft recommendation posted by the USPSTF in August 2020, and is consistent with the task force’s July 2014 recommendation on the topic. The AAFP supported the 2014 recommendation.

 Atrial Fibrillation: Screening - Final Recommendation Statement

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for atrial fibrillation.

 Results From Screening Tests Can Be High In Anxiety

He was disappointed when the tests showed "mild carotid artery disease" on one side of his neck. As someone who prided himself on his health and fitness, he was disturbed to learn that his results indicated that he was at risk for a stroke. Though his report described the risk as mild, all that mattered to him were the words "disease" and "stroke." By the time he came to see me, I had to work pretty hard to calm him down. My experience with this patient and others like him led to me look at the website for Life Line Screening, the company that performed his tests. There I found testimonials from customers who felt screening had saved their lives, or at least uncovered problems before they became life-threatening.

Articles of Interest

USPSTF Recommendations for Screening for Carotid Stenosis to Prevent Stroke—The Need for More Data

The USPSTF found that the interval evidence did not provide a basis to change their recommendation against screening and issued the D recommendation based on evidence that the harms of screening for carotid artery stenosis in adults who are asymptomatic outweigh the benefits

Affordable stroke-risk screening could save the lives of many children in sub-Saharan Africa with sickle cell disease

Sickle cell disease, whose name reflects the disease’s sickle or crescent moon shape of red blood cells, can affect any major organ, but my primary concern is its effect on the brain. It causes a lower oxygen level and abnormal blood flow in the brain, which is associated with a high risk of stroke. Without treatment, 11% of children with sickle cell disease will have a stroke before they turn 20 years old.

Controversy surrounds screening for strokes

American doctors and patients seem to have a particular affection for high-tech tests and treatments. We're all for the latest and greatest - but for preventing strokes, the basics are still best.

The Scan That Saved My Life

“It is hard to understand how many leaders in the medical profession can object to a one- to two-minute accurate screen of seniors that can find the 7.5% with silent carotid artery disease,” Dr. Lavenson said. Those patients can be “evaluated and managed to prevent them from being one of the 700,000 clot-caused strokes we continue to have annually.”

USPSTF: Do Not Screen for Carotid Artery Stenosis

Based on its review of the evidence, the task force recommended against screening for asymptomatic CAS in the general adult population. This is a “D” recommendation, and applies to adults without a history of stroke or neurologic signs or symptoms of a transient ischemic attack. “The Task Force wants to help prevent people from having a stroke, but screening for CAS is not an effective way to do so,” said Michael Barry, M.D., a member of the task force, in a news release. “Unfortunately, screening for CAS in adults without symptoms does more harm than good, and we continue to recommend against it.”

A Common Test to Screen for Stroke Risk Is Under Review

But the use of carotid-artery screening has been highly controversial, in large part because studies show the ultrasound tests have only moderate sensitivity and can produce false-positive results. Follow-up often leads to more sensitive tests that can actually have adverse effects on the patient; in some cases, people with false-positive test results may end up getting unnecessary invasive surgery, according to the U.S. Preventive Services Task Force, which issued a recommendation in 2007 against screening patients without symptoms of disease.

MRI scan that can predict stroke risk has 'promise to save lives'

Scientists at Oxford University develop non-invasive technique to measure amount of cholesterol in carotid plaques

New blood test predicts risk of heart attack and stroke with twice previous accuracy

New technique, already available in US, could aid in development of cardiovascular drugs.

New Stroke Screening Test Raises Hopes, Worries

Overall, only about two percent of people with symptom-free carotid stenosis suffer a stroke per year when their condition is managed with drugs and lifestyle changes. By contrast, carotid surgery performed by experienced surgeons triggers a fatal stroke in as many as three percent.

Screening for Asymptomatic Carotid Artery Stenosis: U.S. Preventive Services Task Force Recommendation Statement

Although screening with ultrasonography has few direct harms, all screening strategies, including those with or without confirmatory tests (that is, digital subtraction or magnetic resonance angiography), have imperfect sensitivity and specificity and could lead to unnecessary surgery and result in serious harms, including death, stroke, and MI. There is no evidence that screening by auscultation of the neck to detect carotid bruits is accurate or provides benefit.

Screening for Atrial Fibrillation US Preventive Services Task Force Recommendation Statement

The US Preventive Services Task Force (USPSTF) concludes that evidence is lacking, and the balance of benefits and harms of screening for AF in asymptomatic adults cannot be determined.

Stroke Prevention Screening

Stroke prevention screening is offered for adults of any age but is highly recommended for those with a higher risk of experiencing a stroke.

Three Methods of Screening for Stroke Risk

As a method of prevention, we are encouraged to exercise regularly, maintain a healthy weight, limit sodium intake, and fill our plates with healthy, fresh foods. Physicians may also recommend stroke screening for individuals with family history factors or other risks.

Two Simple Tests Can Prevent Stroke, But Few Get Them

To prevent stroke, two tests are crucial -- neither of them well-known to the public. One is called a carotid ultrasound. It spots fatty plaque buildup in the carotid arteries on each side of the neck.

USPSTF Releases Update on Harms vs Benefits of Atrial Fibrillation Screening

This review found that there is still a need for long-term research into whether AF screening programs are effective at identifying more cases of asymptomatic AF, ultimately decreasing risk for stroke and related morbidity and mortality. Only 1 trial was found that was designed and powered to evaluated health outcomes of AF screening. This trial, however, had no formal masking and recruited patients with known AF, which may have obscured some findings. “Although screening can detect more cases of previously unknown AF, evidence regarding effects on health outcomes is limited,” the USPSTF stated. “Anticoagulation was associated with lower risk of first stroke and mortality but with increased risk of major bleeding, although estimates for this harm are imprecise.”