Screening Asymptomatic Adults for Coronary Heart Disease With Resting or Exercise Electrocardiography: Systematic Review to Update the 2004 U.S. ... Recommendation: Evidence Synthesis Number 88
Screening Asymptomatic Adults for Coronary Heart Disease With Resting or Exercise Electrocardiography: Systematic Review to Update the 2004 U.S. ... Recommendation: Evidence Synthesis Number 88
Overview
Coronary heart disease (CHD) is the leading cause of death in the United States in both men and women, accounting for nearly 40 percent of all deaths each year. Each year, more than 1 million Americans experience nonfatal or fatal myocardial infarction (MI) or sudden death from CHD. Although angina is a common presenting symptom of CHD, in some persons the first manifestation of CHD is MI, sudden death, or another serious cardiovascular event. The risk for incident CHD in asymptomatic persons can be predicted based on the “traditional” risk factors included in the Framingham risk score (age, sex, blood pressure, serum total cholesterol level, low-density lipoprotein [LDL] or high-density lipoprotein [HDL] cholesterol level, cigarette smoking, and diabetes). However, these factors do not explain all of the excess risk. Consequently, there has been a long-standing interest in supplementing traditional risk factor assessment with other methods of screening for CHD, including resting or exercise electrocardiography (ECG). Abnormal findings on ECG might identify those at higher risk of CHD events who would not be identified based on traditional risk factors alone. For example, based on the Framingham risk scoring system, persons at intermediate risk are typically defined as having a 10 to 20 percent risk for CHD death or nonfatal MI over 10 years. Abnormal findings on resting or exercise ECG could reclassify some of these persons as low risk (10-year risk less than10 percent) and others as high risk (10-year risk greater than 20 percent). Such reclassification, if accurate, could guide use of more aggressive cardiovascular risk reduction therapies in persons reclassified as high risk, which might reduce future CHD events.6 However, direct evidence showing benefits associated with implementation of such strategies is lacking, and the classification thresholds remain somewhat arbitrary. The U.S. Preventive Services Task Force (USPSTF) last reviewed the evidence on screening for CHD with resting or exercise ECG in 2004. The USPSTF commissioned an update of the evidence review in 2009 in order to revisit its recommendation on screening with resting or exercise ECG. The purpose of this report is to systematically evaluate the current evidence on whether screening asymptomatic adults for CHD with resting or exercise ECG improves clinical outcomes, affects use of risk reduction therapies, or results in accurate reclassification into different risk categories. This report also systematically reviews the evidence on harms associated with screening. In addition to including new evidence, this report differs from earlier USPSTF reviews by focusing on studies that assessed the usefulness of screening after adjusting for traditional cardiovascular risk factors, in order to better understand the incremental value of resting or exercise ECG. In addition, we performed meta-analysis on the association between selected resting and exercise ECG abnormalities and subsequent cardiovascular events.The investigators, USPSTF members, and Agency for Healthcare Research and Quality (AHRQ) Medical Officers developed the scope and key questions used to guide this review. The analytic framework shows the key questions used to guide the review. Key Question 1. What are the benefits of screening for abnormalities with resting or exercise ECG compared with no screening on CHD outcomes? Key Question 2. How does the identification of high-risk persons via resting or exercise ECG affect use of treatments to reduce cardiovascular risk? Key Question 3. What is the accuracy of resting or exercise ECG for stratifying persons into high-, intermediate-, and low-risk groups? Key Question 4. What are the harms of screening with resting or exercise ECG?Description
Condition Guidelines
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The following guidelines apply to books:
- New: A brand-new copy with cover and original protective wrapping intact. Books with markings of any kind on the cover or pages, books marked as "Bargain" or "Remainder," or with any other labels attached, may not be listed as New condition.
- Used - Good: All pages and cover are intact (including the dust cover, if applicable). Spine may show signs of wear. Pages may include limited notes and highlighting. May include "From the library of" labels. Shrink wrap, dust covers, or boxed set case may be missing. Item may be missing bundled media.
- Used - Acceptable: All pages and the cover are intact, but shrink wrap, dust covers, or boxed set case may be missing. Pages may include limited notes, highlighting, or minor water damage but the text is readable. Item may but the dust cover may be missing. Pages may include limited notes and highlighting, but the text cannot be obscured or unreadable.
Note: Some electronic material access codes are valid only for one user. For this reason, used books, including books listed in the Used – Like New condition, may not come with functional electronic material access codes.
Shipping & Delivery
Shipping Fees
- Stevens Books offers FREE SHIPPING everywhere in the United States for ALL non-book orders, and $3.99 for each book.
- Packages are shipped from Monday to Friday.
- No additional fees and charges.
Delivery Times
The usual time for processing an order is 24 hours (1 business day), but may vary depending on the availability of products ordered. This period excludes delivery times, which depend on your geographic location.
Estimated delivery times:
- Standard Shipping: 5-8 business days
- Expedited Shipping: 3-5 business days
Shipping method varies depending on what is being shipped.
Tracking
All orders are shipped with a tracking number. Once your order has left our warehouse, a confirmation e-mail with a tracking number will be sent to you. You will be able to track your package at all times.
Damaged Parcel
If your package has been delivered in a PO Box, please note that we are not responsible for any damage that may result (consequences of extreme temperatures, theft, etc.).
If you have any questions regarding shipping or want to know about the status of an order, please contact us or email to support@stevensbooks.com.
Returns & Refunds
You may return most items within 30 days of delivery for a full refund.
To be eligible for a return, your item must be unused and in the same condition that you received it. It must also be in the original packaging.
Several types of goods are exempt from being returned. Perishable goods such as food, flowers, newspapers or magazines cannot be returned. We also do not accept products that are intimate or sanitary goods, hazardous materials, or flammable liquids or gases.
Additional non-returnable items:
- Gift cards
- Downloadable software products
- Some health and personal care items
To complete your return, we require a tracking number, which shows the items which you already returned to us.
There are certain situations where only partial refunds are granted (if applicable)
- Book with obvious signs of use
- CD, DVD, VHS tape, software, video game, cassette tape, or vinyl record that has been opened
- Any item not in its original condition, is damaged or missing parts for reasons not due to our error
- Any item that is returned more than 30 days after delivery
Items returned to us as a result of our error will receive a full refund,some returns may be subject to a restocking fee of 7% of the total item price, please contact a customer care team member to see if your return is subject. Returns that arrived on time and were as described are subject to a restocking fee.
Items returned to us that were not the result of our error, including items returned to us due to an invalid or incomplete address, will be refunded the original item price less our standard restocking fees.
If the item is returned to us for any of the following reasons, a 15% restocking fee will be applied to your refund total and you will be asked to pay for return shipping:
- Item(s) no longer needed or wanted.
- Item(s) returned to us due to an invalid or incomplete address.
- Item(s) returned to us that were not a result of our error.
You should expect to receive your refund within four weeks of giving your package to the return shipper, however, in many cases you will receive a refund more quickly. This time period includes the transit time for us to receive your return from the shipper (5 to 10 business days), the time it takes us to process your return once we receive it (3 to 5 business days), and the time it takes your bank to process our refund request (5 to 10 business days).
If you need to return an item, please Contact Us with your order number and details about the product you would like to return. We will respond quickly with instructions for how to return items from your order.
Shipping Cost
We'll pay the return shipping costs if the return is a result of our error (you received an incorrect or defective item, etc.). In other cases, you will be responsible for paying for your own shipping costs for returning your item. Shipping costs are non-refundable. If you receive a refund, the cost of return shipping will be deducted from your refund.
Depending on where you live, the time it may take for your exchanged product to reach you, may vary.
If you are shipping an item over $75, you should consider using a trackable shipping service or purchasing shipping insurance. We don’t guarantee that we will receive your returned item.
Overview
Coronary heart disease (CHD) is the leading cause of death in the United States in both men and women, accounting for nearly 40 percent of all deaths each year. Each year, more than 1 million Americans experience nonfatal or fatal myocardial infarction (MI) or sudden death from CHD. Although angina is a common presenting symptom of CHD, in some persons the first manifestation of CHD is MI, sudden death, or another serious cardiovascular event. The risk for incident CHD in asymptomatic persons can be predicted based on the “traditional” risk factors included in the Framingham risk score (age, sex, blood pressure, serum total cholesterol level, low-density lipoprotein [LDL] or high-density lipoprotein [HDL] cholesterol level, cigarette smoking, and diabetes). However, these factors do not explain all of the excess risk. Consequently, there has been a long-standing interest in supplementing traditional risk factor assessment with other methods of screening for CHD, including resting or exercise electrocardiography (ECG). Abnormal findings on ECG might identify those at higher risk of CHD events who would not be identified based on traditional risk factors alone. For example, based on the Framingham risk scoring system, persons at intermediate risk are typically defined as having a 10 to 20 percent risk for CHD death or nonfatal MI over 10 years. Abnormal findings on resting or exercise ECG could reclassify some of these persons as low risk (10-year risk less than10 percent) and others as high risk (10-year risk greater than 20 percent). Such reclassification, if accurate, could guide use of more aggressive cardiovascular risk reduction therapies in persons reclassified as high risk, which might reduce future CHD events.6 However, direct evidence showing benefits associated with implementation of such strategies is lacking, and the classification thresholds remain somewhat arbitrary. The U.S. Preventive Services Task Force (USPSTF) last reviewed the evidence on screening for CHD with resting or exercise ECG in 2004. The USPSTF commissioned an update of the evidence review in 2009 in order to revisit its recommendation on screening with resting or exercise ECG. The purpose of this report is to systematically evaluate the current evidence on whether screening asymptomatic adults for CHD with resting or exercise ECG improves clinical outcomes, affects use of risk reduction therapies, or results in accurate reclassification into different risk categories. This report also systematically reviews the evidence on harms associated with screening. In addition to including new evidence, this report differs from earlier USPSTF reviews by focusing on studies that assessed the usefulness of screening after adjusting for traditional cardiovascular risk factors, in order to better understand the incremental value of resting or exercise ECG. In addition, we performed meta-analysis on the association between selected resting and exercise ECG abnormalities and subsequent cardiovascular events.The investigators, USPSTF members, and Agency for Healthcare Research and Quality (AHRQ) Medical Officers developed the scope and key questions used to guide this review. The analytic framework shows the key questions used to guide the review. Key Question 1. What are the benefits of screening for abnormalities with resting or exercise ECG compared with no screening on CHD outcomes? Key Question 2. How does the identification of high-risk persons via resting or exercise ECG affect use of treatments to reduce cardiovascular risk? Key Question 3. What is the accuracy of resting or exercise ECG for stratifying persons into high-, intermediate-, and low-risk groups? Key Question 4. What are the harms of screening with resting or exercise ECG?Description
Condition Guidelines
Books - New and Used
The following guidelines apply to books:
- New: A brand-new copy with cover and original protective wrapping intact. Books with markings of any kind on the cover or pages, books marked as "Bargain" or "Remainder," or with any other labels attached, may not be listed as New condition.
- Used - Good: All pages and cover are intact (including the dust cover, if applicable). Spine may show signs of wear. Pages may include limited notes and highlighting. May include "From the library of" labels. Shrink wrap, dust covers, or boxed set case may be missing. Item may be missing bundled media.
- Used - Acceptable: All pages and the cover are intact, but shrink wrap, dust covers, or boxed set case may be missing. Pages may include limited notes, highlighting, or minor water damage but the text is readable. Item may but the dust cover may be missing. Pages may include limited notes and highlighting, but the text cannot be obscured or unreadable.
Note: Some electronic material access codes are valid only for one user. For this reason, used books, including books listed in the Used – Like New condition, may not come with functional electronic material access codes.
Shipping & Delivery
Shipping Fees
- Stevens Books offers FREE SHIPPING everywhere in the United States for ALL non-book orders, and $3.99 for each book.
- Packages are shipped from Monday to Friday.
- No additional fees and charges.
Delivery Times
The usual time for processing an order is 24 hours (1 business day), but may vary depending on the availability of products ordered. This period excludes delivery times, which depend on your geographic location.
Estimated delivery times:
- Standard Shipping: 5-8 business days
- Expedited Shipping: 3-5 business days
Shipping method varies depending on what is being shipped.
Tracking
All orders are shipped with a tracking number. Once your order has left our warehouse, a confirmation e-mail with a tracking number will be sent to you. You will be able to track your package at all times.
Damaged Parcel
If your package has been delivered in a PO Box, please note that we are not responsible for any damage that may result (consequences of extreme temperatures, theft, etc.).
If you have any questions regarding shipping or want to know about the status of an order, please contact us or email to support@stevensbooks.com.
Returns & Refunds
You may return most items within 30 days of delivery for a full refund.
To be eligible for a return, your item must be unused and in the same condition that you received it. It must also be in the original packaging.
Several types of goods are exempt from being returned. Perishable goods such as food, flowers, newspapers or magazines cannot be returned. We also do not accept products that are intimate or sanitary goods, hazardous materials, or flammable liquids or gases.
Additional non-returnable items:
- Gift cards
- Downloadable software products
- Some health and personal care items
To complete your return, we require a tracking number, which shows the items which you already returned to us.
There are certain situations where only partial refunds are granted (if applicable)
- Book with obvious signs of use
- CD, DVD, VHS tape, software, video game, cassette tape, or vinyl record that has been opened
- Any item not in its original condition, is damaged or missing parts for reasons not due to our error
- Any item that is returned more than 30 days after delivery
Items returned to us as a result of our error will receive a full refund,some returns may be subject to a restocking fee of 7% of the total item price, please contact a customer care team member to see if your return is subject. Returns that arrived on time and were as described are subject to a restocking fee.
Items returned to us that were not the result of our error, including items returned to us due to an invalid or incomplete address, will be refunded the original item price less our standard restocking fees.
If the item is returned to us for any of the following reasons, a 15% restocking fee will be applied to your refund total and you will be asked to pay for return shipping:
- Item(s) no longer needed or wanted.
- Item(s) returned to us due to an invalid or incomplete address.
- Item(s) returned to us that were not a result of our error.
You should expect to receive your refund within four weeks of giving your package to the return shipper, however, in many cases you will receive a refund more quickly. This time period includes the transit time for us to receive your return from the shipper (5 to 10 business days), the time it takes us to process your return once we receive it (3 to 5 business days), and the time it takes your bank to process our refund request (5 to 10 business days).
If you need to return an item, please Contact Us with your order number and details about the product you would like to return. We will respond quickly with instructions for how to return items from your order.
Shipping Cost
We'll pay the return shipping costs if the return is a result of our error (you received an incorrect or defective item, etc.). In other cases, you will be responsible for paying for your own shipping costs for returning your item. Shipping costs are non-refundable. If you receive a refund, the cost of return shipping will be deducted from your refund.
Depending on where you live, the time it may take for your exchanged product to reach you, may vary.
If you are shipping an item over $75, you should consider using a trackable shipping service or purchasing shipping insurance. We don’t guarantee that we will receive your returned item.
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