While echocardiographic screening for structural heart disease is recommended in patients with a family history of cardiac arrest or hereditary conditions affecting the heart or great vessels, whether echocardiographic screening is warranted in the general population is unknown.
The study consisted of 6,861 patients randomized to echocardiographic screening (n=3,272) or a control group (n=3,589). The study population was drawn from the Tromsø Study—a prospective, population-based cohort study conducted in Norway. Extensive data on participants was obtained through self-reported questionnaires and physical examinations. Individuals with pre-defined echocardiographic abnormalities were referred for clinical follow-up. The primary outcome was all-cause mortality. In the group screened by echocardiography, 362 (8.9%) patients met criteria for clinical referral. A total of 15.2% of referred individuals with echocardiographic abnormalities did not obtain clinical follow-up. Of 290 patients seen in follow-up, pathologic cardiac conditions were verified in 249 (7.6%) individuals who subsequently received treatment. During the 15-year follow-up, no difference was seen in all cause-mortality (HR 0.97; 95% CI 0.89 – 1.06) or cardiac mortality (HR 0.91; 95% CI 0.77 – 1.08) in the echocardiographically screened group compared with the control group.
Conclusions: Echocardiographic screening of the general population does not appear to reduce mortality. However, the generalizability of these findings is limited given the homogenous Norwegian population studied. Moreover, 15% of individuals with abnormal echocardiograms did not obtain clinical follow-up, which may have attenuated the results.
- Lindekleiv H, Lochen ML, Mathiesen EB, et al. Echocardiographic screening of the general population and long-term survival: A randomized clinical study. JAMA internal medicine. 2013;173:1592-1598