Document Detail


Predictive value of exercise stress testing in a family medicine population.
MedLine Citation:
PMID:  18988720     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Exercise stress testing (EST) is a screening test for coronary artery disease. Previous studies from the cardiology literature show an overall sensitivity of 67% and specificity of 72% with variable predictive values depending on pretest probability. The purpose of the current study was to evaluate the predictive value of EST in a family medicine population in eastern North Carolina. METHODS: This is a retrospective case series of 339 ESTs performed in a family medicine center from July 2001 to April 2005. EST results were classified as positive, negative, or equivocal. Outcomes studied from a review of outpatient and inpatient electronic medical record data and telephone follow-up included myocardial infarction, cardiac catheterization with angioplasty and stenting, coronary artery bypass grafting, a new diagnosis of coronary artery disease, and cardiac death. Mean duration of follow-up was 47 months, with a range of 27 to 72 months. RESULTS: Nearly all patients had low to intermediate risk pretest probability. Five tests were positive, 32 were equivocal, and 302 were negative. There were 2 false-positive tests, both in female patients. There were 2 false-negative tests, both of which were treated with good outcomes. Two of 32 equivocal results had cardiac outcomes. Considering equivocal tests as positive, the overall sensitivity in this series was 71.4%; specificity was 90.4%. The positive predictive value was 13.5% and the negative predictive value was 99.3%. CONCLUSIONS: The high negative predictive value for EST in this outpatient family medicine population is noteworthy and reassuring. EST is a cost-effective strategy for triaging the common complaint of chest pain in low- to intermediate-risk patients in primary care practices and should be included in the services offered to family medicine patients.
Authors:
Robert J Newman; Mark Darrow; Doyle M Cummings; Valerie King; Lauren Whetstone; Suzanne Kelly; Eric Jalonen
Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Journal of the American Board of Family Medicine : JABFM     Volume:  21     ISSN:  1557-2625     ISO Abbreviation:  -     Publication Date:    2008 Nov-Dec
Date Detail:
Created Date:  2008-11-07     Completed Date:  2009-02-11     Revised Date:  2009-04-16    
Medline Journal Info:
Nlm Unique ID:  101256526     Medline TA:  J Am Board Fam Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  531-8     Citation Subset:  IM    
Affiliation:
East Carolina University, Department of Family Medicine, Brody School of Medicine, 600 Moye Blvd, Greenville, North Carolina 27834, USA. newmanr@ecu.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Ambulatory Care Facilities
Coronary Artery Disease / diagnosis*,  physiopathology
Exercise Test*
Family Practice*
Female
Humans
Male
Middle Aged
North Carolina
Outpatients
Predictive Value of Tests
Retrospective Studies
Sensitivity and Specificity
Comments/Corrections
Comment In:
J Am Board Fam Med. 2009 Mar-Apr;22(2):224   [PMID:  19264951 ]
J Am Board Fam Med. 2009 Mar-Apr;22(2):223-4   [PMID:  19264950 ]

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


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