There is very little evidence that screening tests reduce mortality in asymptomatic individuals. However, clinicians have a strong belief that diagnostic tests can help find disease in its earliest stages. That is why many top-ranking hospitals offer executive screening programmes that are primarily targeted to wealthy individuals who can afford to pay for tests that are generally not covered by insurance.
Cardiovascular disease is one of the leading causes of mortality in the US. In this review, cardiovascular examinations at executive health screening programmes offered by the top hospitals for cardiology and heart surgery were assessed. Data for the analysis were obtained via telephone. Hospital administrators of top-ranked hospitals, as per the US News & World Report ranking of Best Hospitals for cardiology and heart surgery, were included in this analysis. The researchers gathered basic information about these screening programmes such as the different packages, the cost, the appointment fee, insurance process and information brochure. The tests offered by the different screening programmes were then compared with the recommendations for asymptomatic individuals by the American College of Cardiology/American Heart Association (ACC/AHA), the United States Preventive Services Task Force (USPSTF), and the American College of Preventive Medicine (ACPM).
21 hospitals responded to the inquiries out of which 18 offered 28 different executive health screening programmes. The total costs with appointment fees ranged from $995 for Comprehensive Health Assessment at the 13th ranked hospital - Houston Methodist Hospital - to $25 000 for a Premier Executive Health Program at the top-ranked hospital - Cleveland Clinic. Only three programmes offered insurance coverage. Overall, 12 different cardiovascular screening tests and a resting ECG were offered by the executive physical programmes. In addition, other tests that were commonly offered by these programmes included a lipid panel and a cardiac stress test. 12 of 28 programmes also offered cardiac computed tomographic scanning while cardiovascular counselling was included in only 2 programmes, and exercise consultation was included in 1 programme. It is important to note that of all the 12 tests offered by these executive screening programmes, none of them are recommended by the ACC/AHA, USPSTF, or ACPM.
In other words, the executive screening programmes provided by the top-rated cardiology hospitals in the US are not recommended by current guidelines for use among asymptomatic individuals. The premise that these tests may reduce mortality from cardiovascular disease through early detection or more precise risk assessment is not supported by any data or guidelines.
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