Exercise stress testing in the asymptomatic adult: family physician adherence to the guidelines

Objective

Exercise stress testing has not been recommended by the American Heart Association or the American College of Cardiology as a screening tool in the asymptomatic population because such testing has limited value in this population. It was the goal of this study to investigate family physician adherence to clinical guidelines regarding exercise stress testing of the asymptomatic adult.

Methods

This trial surveyed osteopathic family physicians attending a continuing education conference. Physician identifiers were not requested or recorded. Both descriptive and inferential statistics were produced. Frequencies and percentages as well as chi-square analysis were performed with significance set at an α ≤ 0.05.

Results

A total of 181 osteopathic family physicians completed surveys. Participating physicians were more likely to order a stress test as the patient aged and as their Framingham risk increased. Universally more physicians ordered stress tests for men than women in all categories. Non-diabetic men (83% vs. 86%) and women (83% vs. 84.5%) greater than 59 years of age who planned to start an exercise program were stress tested with greater frequency than their age matched diabetic counterparts (p < 0.001, p < 0.001).

Conclusions

This study demonstrates that physician use of exercise stress testing as a screening tool for coronary heart disease is not well correlated with American Heart Association/American College of Cardiology evidence-based guidelines. The study also identified a lack of recognition of diabetes as a cardiovascular risk equivalent. Further studies are needed to delineate potential barriers to physician adherence of these guidelines.

Keywords: Exercise stress test, Cardiovascular disease, Screening