Sudden death in the population from undetected heart conditions has a devastating impact on families and communities. It is therefore understandable that people believe screening is key in avoiding such a tragedy.
However, British Heart Foundation Cymru are keen to emphasise that screening is not yet at a scientific level of precision, whereby all people at risk of sudden cardiac death can be accurately predicted.
The UK National Screening Committee (UK NSC) explains screening as a process of identifying healthy people to assess if they have a particular condition. Therefore, heart screening would be the process of identifying apparently healthy people to ascertain if they have an undiagnosed heart condition. With current technology, this is not yet completely accurate and heart screening in the general population is not recommended anywhere in the UK.
The number of false positives related with screening tests such as the ECG is worryingly high. The 2019 report from the UK NSC found that screening for conditions associated with sudden cardiac death would cause many individuals to be incorrectly told they have a heart problem. This would ultimately lead to false positives in the UK population for cardiac conditions. This is also true within other populations, according to the American Heart Association (AHA) the prevalence of sudden cardiac death in the USA population is low therefore heart screening will generate more false positives than true positives.
In 2016, the British Medical Journal (BMJ) found that up to 5% of healthy people aged between 14–35 could be incorrectly suspected of having cardiac disease after screening whilst 25% of people with a condition would not be identified.
Research from JAMA Internal Medicine studied 6,861 middle-aged participants to examine whether echocardiographic (echo) screening in the general population improves long-term survival or reduces the risk of cardiovascular disease. The study ultimately concluded that screening did not reduce the risk of death.
The impacts of misdiagnoses can be huge. False positives associated with heart screening can result in secondary testing, meaning possible inappropriate medical treatment and psychological trauma. Other consequences include reduced employment opportunities, increased demand on secondary services and an impact on insurability.
Recommendations from the UK NSC on whether to screen for a condition are based on internationally recognised criteria and a rigorous evidence review process.
The 2014 UK NSC Screening for cardiac conditions associated with sudden cardiac death in the young report did not recommend the screening of people under the age of 40 as it showed uncertainties surrounding number of people who have been gravely impacted by sudden cardiac death annually. The report concluded that there is currently no evidence to show that screening reduces the chance of a sudden cardiac death in the wider general population.
The UK NSC considered new evidence in 2019 and once again recommended against screening of people for the detection of heart conditions. The report also demonstrates that such tests are not yet accurate enough to use on people to reduce the chance of sudden cardiac death. The report also notes that both the American Heart Association and European Society of Cardiology do not currently support screening of the general population for sudden cardiac death.
British Heart Foundation Cymru are therefore calling on the Welsh Government to continue to follow the guidance of the UK NSC relating to heart screening. The UK NSC currently states that there is guidance on genetic testing family members of people at risk of sudden cardiac death. Effective implementation of this guidance through a targeted screening programme may help prevent sudden cardiac death in some groups of people who are at high risk.
