Home Forums Discussions General Discussion Help with ekg's

I have a long debate here. For routine, asymptomatic, patients who are coming in for PE, do you all do ekg's on everyone one of them. I have seen it done so many ways. I have seen docs who do it on everyone(patients give a star because they think you are so thorough) to docs who don't do them at all unless they are having symptoms.

USPTF guidelines are so vague. NO EKG for low risk indiviuals, males below 50, females below 60(from what I remember) but younger people become higher risk if they have risk factors 1.e. smoker, sedentary which practically is 90% of my patients.

If high risk, they don't have evidence of of for or against doing ekg's in routine PE.

AAFP just just says don't do ekg's at at in routine PE in asymptomatic patients.

How do you all do your ekg's in this type of setting?

I don't do routine office EKGs on any asymptomatic patient with a normal exam. Resting EKG is just not sensitive or specific enough to be valuable. False positive tests greatly outnumber early detection of CAD in asymptomatic adults.

I do office EKGs on patients seen with murmurs or irregular rhythms by exam. I also do them if the patient was told by a previous MD about an abnormal EKG, or if they use meds that affect the EKG (but I guess these aren't really "asymptomatic" patients).

Patients can be evaluated with the NCEP Risk Assessment Tool -- which does not include the EKG. Asymptomatic patients with less than 1% 10 year risk get followed. Asymptomatic patients with over 20% risk need aggressive risk factor modification, but it isn't clear that further testing is useful, since revascularization (if ischemia occurs on further studies) alone doesn't seem to prolong life.

It's the intermediate group that gives me trouble, cardiac event risk over 5% and below 20%. I usually send these patients for exercise testing, or coronary CT if they have coverage, to see how aggressive to get with their lifestyle modifications and drugs. But an EKG doesn't help here either.

John, just curious. Do the insurance companies reimburse you for doing the NCEP Assessment? If so, how much?

No, no extra payment to do the NCEP risk assessment. I have done various things: made it part of the Medicare "wellness annual exam", upped the visit code by one level for discussion time, etc.