In one cohort study, investigators evaluated the use of exercise stress testing for prognostic assessment in older patients compared with their younger counterparts. The older population had more comorbidity, achieved a lower workload, and had a significantly worse unadjusted survival rate than the younger patients.
An exercise stress test is non-invasive and very safe. You’ll be accompanied by a nurse who will monitor your health and check for any concerns.
Few studies have been published on the use of exercise stress testing for prognostic and diagnostic assessment of CAD in older patients (i.e., at least 65 years of age). The prevalence and risk of CAD increase with advancing age. In 1989, the National Health Interview Survey reported that the prevalence of diagnosed CAD was 1.5 percent in women older than 75 years and 1.8 percent in men older than 75 years. However, silent ischemia is present in an estimated 15 percent of 80-year-old patients. Because of the higher rates of CAD in the older population, exercise ECG has a slightly higher sensitivity (84 percent) and lower specificity (70 percent) than in younger populations. This makes ruling out significant disease more difficult.
Most patients presenting to chest pain centers are low risk and this population has a low prevalence of CAD. Adverse outcomes from exercise stress testing in these patients are rare. In one trial, investigators examined the usefulness of chest pain unit exercise stress testing in 424 intermediate-risk patients with unstable angina randomized to a chest pain unit or standard hospital admission. No significant differences in the rates of death, MI, or heart failure were noted between the two groups. Of the patients in the chest pain unit group, 60 met hospitalization criteria before stress testing, 55 had an intermediate-or high-risk test result, and 97 had a negative stress test. No complications were related directly to the performance of a stress test in these patients. These results illustrate that exercise stress testing is safe in low-risk and appropriately selected intermediate-risk patients who present to the emergency department.
|Exercise Stress Test|