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ECG-based cardiac screening programs: Legal, ethical, and logistical considerations.
- Source :
-
Heart rhythm [Heart Rhythm] 2019 Oct; Vol. 16 (10), pp. 1584-1591. Date of Electronic Publication: 2019 Mar 29. - Publication Year :
- 2019
-
Abstract
- 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.<br /> (Copyright © 2019 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adolescent
Adult
Asymptomatic Diseases
Atrial Fibrillation physiopathology
Australia
Eligibility Determination ethics
Eligibility Determination legislation & jurisprudence
Female
Heart Diseases diagnostic imaging
Heart Diseases epidemiology
Heart Diseases physiopathology
Humans
Male
Program Development
Program Evaluation
Young Adult
Athletes statistics & numerical data
Atrial Fibrillation diagnostic imaging
Death, Sudden, Cardiac prevention & control
Electrocardiography methods
Mass Screening organization & administration
Subjects
Details
- Language :
- English
- ISSN :
- 1556-3871
- Volume :
- 16
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Heart rhythm
- Publication Type :
- Academic Journal
- Accession number :
- 30930331
- Full Text :
- https://doi.org/10.1016/j.hrthm.2019.03.025