Should You Schedule the Riverview Heart Screening (available through the end of February)?

Today I had the Riverview Hospital (Noblesville) “Love Your Heart” screening tests which are available throughout February.(1) If you decide you’d like these tests for yourself or a loved one, call Riverview at 317-776-7247. The tests include a CT calcium score, an electrocardiogram, a carotid duplex scan, an abdominal aorta scan for aneurysm, an ankle/brachial index exam, and a blood test; all for only $99.

These tests detect silent blood vessel damage (cholesterol buildup) that can mean an increased risk of heart attack and stroke. By finding silent damage before it causes heart or brain damage, you and your doctor can take steps to markedly reduce your risk (with healthy living habits and medicines).

In this post I’m going to talk about who might most benefit from the heart screening.  And just as important, I’m going go over the AHA guideline as to who does not need the tests and also of who should ask their doctor if they need the tests. (2)

The purpose of heart screening tests is to detect silent heart disease before the patient has symptoms or a heart attack or a stroke.

By adopting healthy living habits and medicines a person at high risk can reduce the risk by 40% or more. The number of heart attacks and strokes have gone way down because of medicines and healthy living habits.

First of all, if you are having any symptoms that could be due to your heart (chest discomfort, shortness of breath, dizziness, fatigue, or swelling of your ankles and feet),then you don’t need these tests. You need to see your doctor to see what’s going on and what tests you do need.

These tests could all be normal and the symptoms could still be a warning of heart trouble. That’s why people with symptoms need to see their doctor first.

These tests are for people who aren’t having any symptoms, people who feel fine. These tests look for evidence of silent damage and silent cholesterol buildup in the arteries.

The American Heart Association (AHA) has a guideline that gives physicians and patients guidance on who may benefit from heart screening programs like the Riverview “Love Your Heart Program”. (2)

All the discussion that follows is based on this AHA guideline.

The first step in deciding whether you need this test is to figure out your overall risk of heart attack or heart attack death using the Framingham Risk Calculator. (3) There are other risk scores that can be used and are listed in table 2, p 2754 of AHA guide. (2).

The Framingham Risk Calculator is very easy to use. You just click on the link below (3) and fill in the boxes. You’ll fill in your age, sex, total cholesteol, HDL cholesterol, whether or not you smoke, your systolic blood pressure, and whether or not you are taking high blood pressure medicine.

You’ll hit the calculate button and you will be told your ten year risk of having a heart attack.

For purposes of risk stratification, people are considered to be at low, intermediate, or high risk based on the Framingham Risk Calculator.

Low risk means a less than 10% risk of a heart attack over the next ten years.

Intermediate risk means a 10% to 20% risk.

And high risk means a greater than 20% risk of heart attack over the next ten years.

The people who can most benefit from the type of heart tests that Riverview is offering in the “Love Your Heart” screening are people who are at intermediate risk.

If you are at high risk, you don’t need the tests because you should already be doing everything you can (healthy living and medicines) to lower your risk.

If you are at low risk, you don’t need to get the tests because they are unlikely to change what your doctor recommends.

However, if the calculator shows you are at low risk you should answer the ten questions about medical history on the article Are You at High Risk of Heart Attack Due to Your Past Medical History? (4) If you answer yes to any of these questions then you are at high risk even though the Framingham Risk Calculator says low risk. And that means you and your doctor need to work vigorously together to prevent trouble.

But if you are at intermediate risk, a 10% to 20% risk, these tests can help determine if you actually are at high risk (due to silent cholesterol buildup in the arteries of heart, to your brain, or to your legs). And if these tests show high risk your doctor will want you to go all out on risk reduction (healthy living habits and medicines).

Another group of people who may benefit from getting the heart screening tests are people with a strong family history of premature heart disease (heart disease before age 55 years in male relatives and before 65 years of age in female relatives). People with a strong family history may have silent blood vessel damage (cholesterol buildup in the arteries) even if their Framingham Risk Score is low.

Now actually, what I just told you are the recommendations based on reference (2). My Framingham Risk Score indicates low risk. So I didn’t “need” the heart screening according to the AHA guideline. But I wanted to have the tests anyway, so I got them.

(1) I am an Internal Medicine specialist (adult medicine) and I also care for pediatric patients.

(2) 2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults: Executive Summary available at: http://circ.ahajournals.org/content/122/25/2748.full.pdf

(3) The Framingham Risk Calculator is available at
http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype#pro.

(4) Are You at High Risk of Heart Attack Due to Your Past Medical History? available at: https://www.tomwademd.net/2012/02/09/are-you-at-high-risk-of-heart-attack-due-to-your-past-medical-history/

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