A survey of exercise testing: methods, utilization, interpretation, and safety in the VAHCS.
A survey of exercise testing: methods, utilization, interpretation, and safety in the VAHCS.
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DOI：
10.1097/00008483-200007000-00007
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发表时间：
2000-07-01
期刊：
影响因子：
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通讯作者：
Froelicher, V F
中科院分区：
文献类型：
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作者：
Myers, J;Voodi, L;Froelicher, V F
背景：医疗机构正在根据其遵守实践指南的程度进行分级。作者在退伍军人事务卫生保健系统（VAHCS）中寻找运动测试的实践模式的信息，以确定当前的实践模式如何遵守当前的指导方针。此外，我们试图更新过去的调查，以确定方法、适应症、替代诊断模式的使用、解释标准、安全性以及VAHCS中运动试验的医生监督。方法：向72家最大的设有心脏病科的退伍军人事务医疗中心发送问卷。向各中心询问了运动试验的量和类型（标准、核和超声心动图）、适应症、安全性、使用的方案和解释标准。结果：共收回71份问卷，其中包括去年进行的75,828次运动测试。几乎所有运动测试的适应症都符合美国心脏协会/美国心脏病学会（AHA/ACC）指南的I类标准；46%的患者接受了胸痛评估测试；14%用于评估冠状动脉疾病高危患者；10%为术前评估；8%为心肌梗死后评估。最常用的诊断检查是标准运动心电图；患者接受标准运动心电图或核运动试验的可能性是运动或药物超声心动图的5倍。最大比例的中心（49%）使用1.0 mm水平或下坡ST凹陷作为异常测试的标准，尽管22%的中心认为1.5 mm上坡ST凹陷是异常的，25%的中心依赖于跑步机评分。78%的受访者使用跑步机，其中82%的人使用布鲁斯或修改的布鲁斯方案。报告了4例主要心脏事件（3例心肌梗死，1例持续性室性心动过速），发生率为1.2/10,000。在73%的标准运动测试中有医生在场；21%的受访者表示，“只有高风险患者”才需要医生在场。结论：运动试验的适应症与AHA/ACC指南非常一致；因此，该测试在冠状动脉疾病或疑似冠状动脉疾病患者的诊断和预后中仍然具有重要作用。运动测试是一种极其安全的程序，事故率与最近的其他调查相似。然而，就异常结果的标准和运动试验中是否需要医生在场而言，存在很大的差异。
BACKGROUND: Healthcare organizations are being graded in terms of their adherence to practice guidelines. The authors sought information on practice patterns of exercise testing within the Veterans Affairs Health Care System (VAHCS) to determine how well current practice patterns adhere to current guidelines. In addition, we sought to update past surveys to determine methods, indications, utilization of alternative diagnostic modalities, criteria for interpretation, safety, and physician supervision of exercise testing within the VAHCS.METHODS: Questionnaires were sent to 72 of the largest Veterans Affairs Medical Centers with cardiology divisions. The centers were queried regarding volume and type of exercise testing (standard, nuclear, and echocardiographic), indications, safety, protocols used, and criteria for interpretation.RESULTS: Seventy-one questionnaires were returned, comprising a total of 75,828 exercise tests performed within the last year. Virtually all indications for exercise testing fit the American Heart Association/American College of Cardiology (AHA/ACC) guidelines Class I criteria; 46% of patients were tested for the evaluation of chest pain; 14% were tested to evaluate patients at high risk for coronary artery disease; 10% were preoperative evaluations; and 8% were post-myocardial infarction evaluations. The most commonly used diagnostic test was the standard exercise electrocardiogram; a patient was five times more likely to undergo a standard exercise electrocardiogram or nuclear exercise test than an exercise or pharmacologic echocardiogram. The largest proportion of centers (49%) used 1.0-mm horizontal or downsloping ST depression as a criterion for an abnormal test, although 22% considered 1.5-mm upsloping ST depression to be abnormal, and 25% relied on a treadmill score. Seventy-eight percent of respondents used the treadmill, and of these, 82% used the Bruce or modified Bruce protocol. Four major cardiac events were reported (three myocardial infarctions, one sustained ventricular tachycardia) representing an event rate of 1.2/10,000. A physician was present during 73% of all standard exercise tests; 21% of respondents reported that a physician was required to be present "only for high-risk patients."CONCLUSION: Indications for exercise testing are in close agreement with the AHA/ACC guidelines; thus, the test continues to have an important role in diagnosis and prognosis among patients with or suspected of having coronary artery disease. The exercise test is an extremely safe procedure, with an event rate similar to other recent surveys. However, a great deal of variation exists in terms of criteria for abnormal results and whether physician presence is required during exercise testing.