American College of Cardiology/American Heart Association clinical competence statement on stress testing

Ayanian, John Z.; Balady, Gary J.; Beasley, John W.; Brown, Kenneth A.; Gervino, Ernest V.; Paridon, Stephen M.; Quiñones, Miguel Á.; Schlant, Robert C.; Winters, William L.; Achord, James L.; Boone, Alan W.; Hirshfeld, John W.; Lorell, Beverly H.; Rodgers, George P.; Tracy, Cynthia M.; Weitz, Howard H.

doi:10.1016/s0735-1097(00)01029-9

Cited by 74 publications

(23 citation statements)

References 29 publications

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“…For additional details about supervision and interpretation of exercise tests, reference is made to the document on clinical competence in stress testing from the ACCF, AHA, and American College of Physicians. 59 Although exercise testing is considered a safe procedure, 60 acute MI and deaths have been reported during testing. The physician or senior medical (healthcare) professional conducting the test must be trained in advanced cardiopulmonary resuscitation.…”

Section: Exercise Test Supervisionmentioning

confidence: 99%

Exercise Standards for Testing and Training

Fletcher¹,

Ades²,

Kligfield³

et al. 2013

Circulation

1,685

760

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Section: Exercise Test Supervisionmentioning

confidence: 99%

Exercise Standards for Testing and Training

Fletcher¹,

Ades²,

Kligfield³

et al. 2013

Circulation

1,685

760

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“…The preparation of the patient and the endpoints of the test were consistent with current guidelines. 7 In addition to the separate evaluation of exercise capacity, chest pain, and ST-segment changes, these variables were combined into the Duke treadmill score, a composite index of risk that has been well validated in nonhypertensive populations.…”

Section: Stress Testingmentioning

confidence: 99%

Prediction of Outcomes in Hypertensive Patients With Suspected Coronary Disease

et al. 2002

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Abstract-Stress echocardiography has been shown to improve the diagnosis of coronary artery disease in the presence of hypertension, but its value in prognostic evaluation is unclear. We sought to determine whether stress echocardiography could be used to predict mortality in 2363 patients with hypertension, who were followed for up to 10 years (mean 4.0Ϯ1.8) for death and revascularization. Stress echocardiograms were normal in 1483 patients (63%), 16% had resting left ventricular (LV) dysfunction alone, and 21% had ischemia. Abnormalities were confined to one territory in 489 patients (21%) and to multiple territories in 365 patients (15%). Cardiac death was less frequent among the patients able to exercise than among those undergoing dobutamine echocardiography (4% versus 7%, PϽ0.001). The risk of death in patients with a negative stress echocardiogram was Ͻ1% per year. Ischemia identified by stress echocardiography was an independent predictor of mortality in those able to exercise (hazard ratio 2.21, 95% confidence intervals 1.10 to 4.43, Pϭ0.0001) as well as those undergoing dobutamine echo (hazard ratio 2.39, 95% confidence intervals 1.53 to 3.75, Pϭ0.0001); other predictors were age, heart failure, resting LV dysfunction, and the Duke treadmill score. In stepwise models replicating the sequence of clinical evaluation, the results of stress echocardiography added prognostic power to models based on clinical and stress-testing variables. Thus, the results of stress echocardiography are an independent predictor of cardiac death in hypertensive patients with known or suspected coronary artery disease, incremental to clinical risks and exercise results.

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“…13,14 Performance criteria and personnel certification programs have been available from the American College of Sports Medicine (ACSM) for >30 years, but AHA/American College of Physicians statements in this area have been directed at the physician. However, in contemporary exercise laboratories, physicians often provide supervision or oversight but are less frequently physically present for testing.…”

mentioning

confidence: 99%

“…However, in contemporary exercise laboratories, physicians often provide supervision or oversight but are less frequently physically present for testing. "Supervision" has been interpreted in different ways, and for the purposes of this document, 3 categories of physician supervision are used, depending on the type of patient being tested 13 : (1) personal supervision, requiring a physician's presence in the room; (2) direct supervision, requiring a physician to be in the immediate vicinity or on the premises or the floor and available for emergencies (explicitly defined as the ability to be in the testing room within 30 seconds of notification); and (3) general supervision, requiring the physician to be available by phone or by page (generally appropriate for healthy, asymptomatic individuals).The present statement responds to the need to specify the appropriate education, training, experience, and cognitive and procedural skills necessary for nonphysicians to conduct exercise testing and to delineate standards that maintain patient safety. This statement also responds to the need to provide physicians with guidance in terms of cognitive and procedural skills that strengthen their ability to supervise nonphysician health professionals who perform exercise testing.…”

mentioning

confidence: 99%