Trends in referral patterns, invasive management, and mortality in elderly patients referred for exercise stress testing

Abstract Introduction Scarce data are available on the temporal patterns in clinical characteristics and outcomes of elderly patients referred for exercise stress testing. We aimed to assess the trends in baseline characteristics, tests results, referrals for invasive management, and mortality in th...

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Published in:European journal of internal medicine 2015-12, Vol.26 (10), p.787-791
Main Authors: Bouzas-Mosquera, Alberto, Peteiro, Jesús, Broullón, Francisco J, Calviño-Santos, Ramón, Mosquera, Víctor X, Barbeito-Caamaño, Cayetana, Larrañaga-Moreira, José María, Maneiro-Melón, Nicolás, Álvarez-García, Nemesio, Vázquez-Rodríguez, José Manuel
Format: Article
Language:English
Subjects:
Aged
Cardiac Imaging Techniques - methods
Cardiac Imaging Techniques - statistics & numerical data
Coronary angiography
Coronary Artery Disease - diagnosis
Coronary Artery Disease - mortality
Disease Management
Exercise stress testing
Exercise Test - methods
Exercise Test - statistics & numerical data
Female
Humans
Internal Medicine
Male
Mortality
Mortality - trends
Myocardial ischemia
Myocardial Revascularization - methods
Myocardial Revascularization - statistics & numerical data
Myocardial Revascularization - trends
Referral and Consultation - statistics & numerical data
Referral and Consultation - trends
Retrospective Studies
Revascularization
Risk Assessment - methods
Severity of Illness Index
Spain - epidemiology
Time Factors
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Summary:Abstract Introduction Scarce data are available on the temporal patterns in clinical characteristics and outcomes of elderly patients referred for exercise stress testing. We aimed to assess the trends in baseline characteristics, tests results, referrals for invasive management, and mortality in these patients. Methods We evaluated 11,192 patients aged ≥ 65 years who were referred for exercise stress testing between January 1998 and December 2013. Calendar years were grouped into four quadrennia (1998–2001, 2002–2005, 2006–2009, and 2010–2013), and trends in clinical characteristics of the patients, type and results of the tests, referrals for invasive management, and mortality across the different periods were assessed. Results Despite a progressive decrease in the proportion of patients with non-interpretable baseline electrocardiograms or prior history of coronary artery disease, there was a gradual and marked increase in the use of cardiac imaging from 32.8% in 1998–2001 to 67.6% in 2010–2013 ( p < 0.001). In addition, despite a gradual decline in the probability of positive exercise stress testing both without imaging (from 18.9 to 13.6%, p < 0.001) and with imaging assessment (from 40.2 to 29.7%, p < 0.001), the cumulative rate of coronary revascularization at 1 year increased (from 10.8 to 13.7%, p < 0.001). One-year mortality also decreased progressively from 3% to 1.6% ( p < 0.001). Conclusions Among older adults referred for exercise stress testing, we observed a decline over time in the probability of inducible myocardial ischemia, an increase in the use of cardiac imaging and in the rate of coronary revascularization, and an improvement in the survival rate at 1 year.
ISSN:0953-6205
1879-0828
DOI:10.1016/j.ejim.2015.08.016