How to address EKG expectations with low-risk patients

Patients accustomed to annual EKGs may be surprised when their new doctor skips the test. This can cause anxiety, especially among seniors, but a clear, evidence-based explanation of the change can help put them at ease.

Read how your peers are managing EKG expectations for low-risk patients on Healthcasts. Then log in or sign up to see the consensus.

Questions for consult 

 Consults

Key takeaways for addressing EKG expectations in low-risk patients: 

• Follow guidelines, not tradition
  Inform the patient that annual EKGs aren’t recommended for people at a low risk for heart conditions. Mention that skipping unnecessary tests saves time, costs, and stress.
• Emphasize safe, effective monitoring
  Routine exams like heart auscultation and vital signs typically catch most issues. Keep baseline labs and prior EKGs on file.
• Communicate respectfully
  Present the change in routine as an evidence-based update, not a criticism of prior care. Consider compromising with an EKG every 3–5 years if needed to maintain trust with the patient.

Family Practice

"I'd order a copy of the baseline labs and EKG and assure they will be kept on file. Without symptoms or cause (such as dyspnea, hx HTN), there is no need for annual EKG. I explain it doesn't reduce the incidence of disease, find problems over a baseline examination, and that there are probably other tests and preventions more cost-effective and worthwhile, such as MMGs, colonoscopies, DEXA, cholesterol screening..."

Cardiology

"If her annual EKGs have always been normal, why would she suddenly expect them to change this year? It would be one thing if she had never had one before. Once in a blue moon, you might find someone who has chronically been in asymptomatic rate-controlled atrial fib, which would require more workup, or you find a left bundle branch block, which might be a red herring or might be a sign of cardiomyopathy or CAD.

But for the majority of people, the EKG in someone with no symptoms (perhaps with the exception of elite athletes who are going to really put their body to the limits of performance) ends up being a waste of time and a cause for a lot of extra worry and extra testing—lots of false positives to chase after."

Internal Medicine

"Don’t throw the other doctor under the bus. Say, 'recent guidelines no longer recommend this test.'"

Family Practice

"People can be used to medicine being practiced a certain way. I would do the best one can to explain how some things that were previously routine are not routine anymore. Explain that it saves them cost, time, and aggravation. That usually appeals to them. And if that doesn't work, one might consider doing the EKG anyway after explaining the risks of a false positive finding."

Family Practice

"I would let her know about guidelines. I would tell her that an annual EKG in asymptomatic patients is not necessary. Assure her that listening to her heart and checking her pulse should pick up any significant problems. Maybe compromise and do an EKG every 3-5 years."

To explore more peer insights on how to successfully address EKG expectations in low-risk patients, or contribute your opinion to the conversation, read the full case on Healthcasts.