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General medicine
Screening ECGs in low-risk patients are associated with increased risk of downstream cardiac testing
  1. Shiwani Mahajan1,2,
  2. Harlan M Krumholz1,2,3
  1. 1 Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
  2. 2 Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
  3. 3 Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
  1. Correspondence to Dr Harlan M Krumholz, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA; harlan.krumholz{at}

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Commentary on: Bhatia RS, Bouck Z, Ivers NM, et al. Electrocardiograms in low-risk patients undergoing an annual health examination. JAMA Intern Med 2017;177:1326–33


Given the rising costs of healthcare and the evidence that about one-third of it is wasteful,1 several initiatives have been established with the goal of identifying wasteful healthcare services that provide little or no benefit to patients.2 One such low-value care practice has been the performance of an electrocardiogram (ECG) in low-risk patients to screen for cardiovascular diseases. The downstream consequence of obtaining an ECG in a low-risk population is not well described in the literature.


This population-based retrospective cohort study was performed using the administrative healthcare databases from Canada between 2010 and 2015.3 The primary exposure was receipt of an ECG within 30 days of an annual health examination (AHE). The study population consisted of all patients ≥18 years …

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  • Contributors SM wrote the first draft of the paper. HMK provided supervision. Both authors interpreted the information the papers is based on, revised the paper for important intellectual content and approved the final submitted version.

  • Competing interests HMK is a recipient of research grants, through Yale, from Medtronic and Johnson & Johnson (Janssen) to develop methods of clinical trial data sharing and from Medtronic to develop methods for postmarket surveillance of medical devices; works under contract with the Centers for Medicare & Medicaid Services to develop and maintain performance measures that are publicly reported; chairs a cardiac scientific advisory board for United Health; is a participant/participant representative of the IBM Watson Health Life Sciences Board; is a member of the Advisory Board for Element Science and the Physician Advisory Board for Aetna and is the founder of Hugo, a personal health information platform.

  • Provenance and peer review Commissioned; internally peer reviewed.