Document Detail


Can we reliably predict long-term mortality after exercise testing? An external validation.
MedLine Citation:
PMID:  16086936     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The aim of the study was to derive and externally validate a mortality prediction rule for patients undergoing exercise testing. BACKGROUND: The prognostic value of exercise testing is increasingly appreciated. However, global prognosis estimates ideally should account for numerous routinely obtained variables, including demographics, risk factors, resting electrocardiogram, and multiple exercise test measures. METHODS: A prediction rule was derived by parametric hazards modeling on a derivation set of 46047 Cleveland Clinic patients (age 55 +/- 11 years, 67% male) who had no history of heart failure, valve disease, or atrial fibrillation. Twenty-two variables covering demographics, risk factors, exercise hemodynamics, and electrocardiogram findings at rest and during exercise were considered. The resulting model included 16 variables and was tested on 4981 patients (age 50 +/- 12 years, 55% male) who underwent exercise testing at West Virginia University. RESULTS: In the derivation cohort there were 3173 deaths during a mean of 7 years of follow-up, whereas in the validation cohort there were 180 deaths during a mean of 5 years of follow-up. Comparisons of predicted and observed death rates showed very good agreement among all patients across all spectrums of risk, as well as among prespecified high-risk subgroups. Model discrimination was also good, with c statistic of c = 0.79 in the derivation group and c = 0.81 in the validation cohort. CONCLUSIONS: We have externally validated a mortality prediction rule for patients undergoing exercise testing and confirmed its accuracy among a wide spectrum of patients.
Authors:
Barbara Hesse; Anthony Morise; Claire E Pothier; Eugene H Blackstone; Michael S Lauer
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.; Validation Studies    
Journal Detail:
Title:  American heart journal     Volume:  150     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-08-09     Completed Date:  2005-12-02     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  307-14     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Calibration
Cardiovascular Diseases / epidemiology
Cause of Death
Cohort Studies
Diabetes Mellitus / epidemiology
Electrocardiography
Exercise / physiology
Exercise Test*
Female
Follow-Up Studies
Hemodynamics
Humans
Male
Middle Aged
Mortality*
Prognosis*
Proportional Hazards Models
Rest / physiology
Risk Factors
Grant Support
ID/Acronym/Agency:
HL-66004/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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