Why screen for cardiovascular disease (CVD)?

Despite tremendous improvements in our understanding of the underlying process of cardiovascular disease (CVD) if you have a heart attack there is still a 30% chance you won't survive. Professor Avijit Lahiri saysDespite tremendous improvements in our understanding of the underlying process of cardiovascular disease (CVD) if you have a heart attack there is still a 30% chance you won't survive. Professor Avijit Lahiri says early detection is critically important -  especially when you consider that almost 80% of heart attack victims have had “silent” heart disease for many years.

Diagnose your pain

It’s vital to obtain an accurate and rapid diagnosis of coronary artery disease at the outset. Chest pains are often the first telltale signs of CVD, however, in many instances the differential diagnosis of chest pain is elusive, leading to a large number of ‘false’ diagnosis, which creates a very significant impact on the NHS.

Stress Electrocardiography (ECG)

In the 1980’s Rapid Access Chest Pain Clinics (RACPCs) were set up in order to systematically evaluate patients and have now become a de facto standard of care within the NHS. The first test which is usually performed on patients presenting with chest pain is a stress electrocardiography (ECG).

Leads are attached to your chest whilst you perform light exercise, usually on a bike or treadmill, to ascertain how your heart functions under stress.  The problem is that the results of Large Clinical trials suggest that incorrect diagnoses from ECG may run as high as 25%. Some patients are unable to perform enough exercise to allow an accurate diagnosis, others give false positive or false negative results.

Doctors are well aware of the shortcomings of stress ECGs. They frequently order subsequent tests such as coronary angiography (CA) even when the stress ECG is normal. This has led to an increase in the number of coronary angiography procedures. Unfortunately, coronary angiography is an invasive and expensive procedure with a small but significant risk of major complications such as; death, heart attack (myocardial infarction - MI) and stroke. This is clearly an unsatisfactory state of affairs, from both a clinical and economic perspective.

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