Surrogates for standards should be considered carefully and justified only when they perform equal to or better than the standard itself. Screening can be defined as the presumptive identification of unrecognized disease by the use of procedures that can be applied rapidly. The relative value of techniques for identifying individuals who have asymptomatic or latent obstructive CAD should be assessed to optimally and cost-effectively direct secondary preventive efforts toward those with disease. The results of intervention outweigh any adverse effects. The target disease has an asymptomatic period during which its outcome can be altered.
Acceptable treatments are available.
The prevalence and seriousness of the disease justify the costs of intervention. The procedure is relatively easy and inexpensive. Sufficient resources are available. Such a study has been completed for mammography but not for any cardiac testing modalities. The next best validation of efficacy is to demonstrate that the technique improves the determination of those asymptomatic individuals with higher risk for events over that possible with the available risk factors.