Abstract TP165: Cardiac Screening Does not Improve One-year Mortality Among Patients With Cerebrovascular Disease

Introduction: Guidelines recommend the use of cardiac stress testing to screen for occult coronary heart disease (CHD) among patients with ischemic stroke/TIA who have a ‘high risk’ Framingham Cardiac Risk score (FCRS). It is unclear whether implementation of this guideline confers a mortality benefit among patients with cerebrovascular disease. Hypothesis: We assessed the hypothesis that cardiac stress testing would be associated with lower odds of one-year all-cause mortality. Methods: Administrative data from a sample of 11,306 Veterans admitted to 134 Veterans Health Administration (VHA) facilities with a stroke or TIA in fiscal year 2011 were analyzed. Patients were excluded (n=6915) on the basis of: prior CHD history, receipt of cardiac stress testing within 18-months prior to cerebrovascular event, death within 90 days of discharge, being discharged to hospice, transferred to a non-VHA acute care facility, or missing/unknown race. A FCRS was calculated for each patient; a score of ≥ 20% was classified as ‘high risk’ of having CHD. Administrative data were used to identify whether cardiac stress testing was performed within 90-days after the cerebrovascular event. Logistic regression was used to assess whether cardiac stress testing was associated with one-year all-cause mortality. Results: Of the 4391 eligible patients, 62.8% (2759) had FCRS ≥ 20%, with 4.5% (n=123) of these patients receiving cardiac stress testing within 90 days of discharge. After adjusting for sociodemographic characteristics and medical comorbidities, FCRS ≥ 20% was associated with one-year mortality (aOR=2.18; CI 95 :1.59, 3.00), however, receipt of stress testing was not (aOR=0.59; CI 95 :0.26, 1.30). Conclusion: Cardiac screening did not confer a one-year all-cause mortality benefit among patients with cerebrovascular disease. Additional work is needed to assess outcomes among patients with cerebrovascular disease who are at ‘high risk’ for CHD.

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Receipt of cardiac screening does not influence 1-year post–cerebrovascular event mortality

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000465 ◽

2018 ◽

Vol 8 (3) ◽

pp. 192-200

Author(s):

Jason J. Sico ◽

Fitsum Baye ◽

Laura J. Myers ◽

John Concato ◽

Jared Ferguson ◽

...

Keyword(s):

High Risk ◽

Cerebrovascular Disease ◽

Stress Testing ◽

Care Facility ◽

Fiscal Year ◽

Similar Proportion ◽

Cerebrovascular Event ◽

Cardiac Stress ◽

Cardiac Screening ◽

Cardiac Stress Testing

BackgroundAmerican Heart Association/American Stroke Association expert consensus guidelines recommend consideration of cardiac stress testing to screen for occult coronary heart disease (CHD) among patients with ischemic stroke/TIA who have a high-risk Framingham Cardiac Risk Score (FCRS). Whether this guideline is being implemented in routine clinical practice, and the association of its implementation with mortality, is less clear.MethodsStudy participants were Veterans with stroke/TIA (n = 11,306) during fiscal year 2011 who presented to a VA Emergency Department or who were admitted. Patients were excluded (n = 6,915) based on prior CHD/angina/chest pain history, receipt of cardiac stress testing within 18 months prior to cerebrovascular event, death within 90 days of discharge, discharge to hospice, transfer to a non-VA acute care facility, or missing/unknown race. FCRS ≥20% was classified as high risk for CHD. ICD-9 and Common Procedural Terminology codes were used to identify receipt of any cardiac stress testing.ResultsAmong 4,391 eligible patients, 62.8% (n = 2,759) had FCRS ≥20%. Cardiac stress testing was performed infrequently and in similar proportion among high-risk (4.5% [123/2,759]) vs low/intermediate-risk (4.4% [72/1,632]) patients (adjusted odds ratio [aOR] 0.77, 95% confidence interval [CI] 0.54–1.10). Receipt of stress testing was not associated with reduced 1-year mortality (aOR 0.59, CI 0.26–1.30).ConclusionsIn this observational cohort study of patients with cerebrovascular disease, cardiac screening was relatively uncommon and was not associated with 1-year mortality. Additional work is needed to understand the utility of CHD screening among high-risk patients with cerebrovascular disease.

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Abstract W P158: Underutilization of Guideline-Concordant Cardiac Screening among Patients with Cerebrovascular Disease

Stroke ◽

10.1161/str.46.suppl_1.wp158 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Jason J Sico ◽

Fitsum Baye ◽

Laura E Myers ◽

John Concato ◽

Linda S Williams ◽

...

Keyword(s):

Blood Pressure ◽

High Risk ◽

Stress Testing ◽

Cerebrovascular Event ◽

Stroke Patients ◽

Cardiac Stress ◽

Cardiac Screening ◽

History Of ◽

Mild Stroke ◽

Cardiac Stress Testing

Introduction: Guidelines recommend the use of cardiac stress testing to screen for occult coronary heart disease (CHD) among patients with TIA and ischemic stroke who have a ‘high risk’ Framingham Risk score (FRS). It is unclear whether TIA/stroke patients regularly receive guideline-concordant cardiac stress testing. Methods: Administrative data from a sample of 10,923 Veterans from admitted to Veterans Health Administration (VHA) facilities with a TIA or mild stroke in fiscal year 2011 were analyzed. Patients were excluded (n=6947) on the basis of a history of CHD, receipt of cardiac stress testing within 18-months prior to cerebrovascular event, patients who died within 90 days of discharge or were discharged to hospice, and those with missing/unknown race. A FRS was calculated for each patient based on: age, gender, race, systolic blood pressure, blood pressure treatment (yes/no), diabetes, smoking status (smoker/non-smoker), and cholesterol (total and high-density lipoprotein). Patients with an FRS ≥20 were classified as ‘high risk’ of having CHD. Administrative data were used to identify whether cardiac stress testing was performed within 6-months after the cerebrovascular event. Results: Of the 3976 TIA/mild stroke patients, 53.9% (2322) had FRS ≥ 20. A higher proportion of patients with FRS ≥ 20 that received cardiac screening were younger, white men with diabetes and without a history of cancer, compared with patients with a FRS ≥ 20 that did not receive testing. Cardiac stress testing was not performed more frequently for ‘high risk’ (4.5%; 104/2322) versus ‘low/intermediate risk’ (4.7%; 77/1654) FRS (OR = 0.96; CI 95 :071-1.30). Conclusions: Guideline concordant cardiac screening is underutilized among patients with TIA and minor ischemic stroke. Additional research is required to: 1) better understand clinicians’ understanding of and approach to cardiac screening for patients with cerebrovascular disease at high risk for CHD; and 2) determine whether cardiac screening improves post-TIA/stroke outcomes.

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Abstract 200: Adherence to Guidelines: Are Ischemic Stroke Patients Receiving Guideline-Concordant Cardiac Stress Testing?

Stroke ◽

10.1161/str.44.suppl_1.a200 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Jason Sico ◽

Laura J Myers ◽

Linda S Williams ◽

Dawn M Bravata

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

High Risk ◽

Stress Testing ◽

Fiscal Year ◽

Health Administration ◽

Cardiac Events ◽

Stroke Patients ◽

Cardiac Stress ◽

Cardiac Stress Testing

Introduction: Current guidelines recommend screening for coronary heart disease (CHD) using cardiac stress testing for ischemic stroke patients at ‘high risk’ of future cardiac events. However, it is unknown whether high risk stroke patients routinely receive guideline concordant cardiac stress testing. Methods: Medical records were abstracted for a sample of 3965 Veterans from 131 Veterans Health Administration (VHA) facilities who were admitted for a confirmed diagnosis of ischemic stroke (fiscal year 2007). Patients with a history of CHD, receipt of cardiac stress testing within 18-months prior to stroke event, and patients who died during the index hospitalization were excluded (n=1628). Framingham Risk Scores (FRS) were calculated on the basis of: age, gender, systolic blood pressure, blood pressure treatment (yes/no), smoking status (smoker/non-smoker), diabetes, total cholesterol, and high-density lipoprotein cholesterol. FRS ≥20 was used to define patients at “high-risk” of CHD. Administrative data were used to determine whether or not cardiac stress testing was performed within 6-months following discharge from the index stroke hospitalization. Logistic regression was used to assess whether cardiac stress testing was performed more frequently among high risk stroke patients. Results: Among 2337 stroke patients, 28% (n=664) had FRS≥20, and a total of 6% (n=140) had cardiac stress testing within 6-months of discharge. Cardiac stress testing was not more frequently performed among those with ‘high risk’ (5.6%) than those with ‘low risk’ (6.2%) FRS. High risk patients (FRS ≥20) were as likely to have received cardiac stress testing as those with low FRS (OR = 0.90; CI95: 0.61-1.32). Conclusions: Guideline concordant cardiac screening is underutilized among ischemic stroke patients without evidence of previous cardiac stress testing. Patients at the highest risk of future cardiac events were not more likely to receive cardiac stress testing than patients with lower risk. Additional research is required to identify potential barriers to CHD screening, and to determine whether outcomes are improved among patients who received CHD screening.

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The early identification of psychosis: can lessons be learnt from cardiac stress testing?

Psychopharmacology ◽

10.1007/s00213-015-4143-3 ◽

2015 ◽

Vol 233 (1) ◽

pp. 19-37 ◽

Cited By ~ 4

Author(s):

Swapnil Gupta ◽

Mohini Ranganathan ◽

Deepak Cyril D’Souza

Keyword(s):

Early Identification ◽

Stress Testing ◽

Cardiac Stress ◽

Cardiac Stress Testing

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Comparison of Preoperative Assessment of Patient’s Metabolic Equivalents (METs) Estimated from History versus Measured by Exercise Cardiac Stress Testing

Anesthesiology Research and Practice ◽

10.1155/2018/5912726 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Adam S. Weinstein ◽

Martin I. Sigurdsson ◽

Angela M. Bader

Keyword(s):

Cardiac Failure ◽

Stress Testing ◽

Stress Test ◽

Preoperative Evaluation ◽

Preoperative Assessment ◽

Exercise Stress ◽

Cardiac Stress ◽

Metabolic Equivalents ◽

Cardiac Stress Testing ◽

Cardiac Stress Test

Background. Preoperative anesthetic evaluations of patients before surgery traditionally involves assessment of a patient’s functional capacity to estimate perioperative risk of cardiovascular complications and need for further workup. This is typically done by inquiring about the patient’s physical activity, with the goal of providing an estimate of the metabolic equivalents (METs) that the patient can perform without signs of myocardial ischemia or cardiac failure. We sought to compare estimates of patients’ METs between preoperative assessment by medical history with quantified assessment of METs via the exercise cardiac stress test. Methods. A single-center retrospective chart review from 12/1/2005 to 5/31/2015 was performed on 492 patients who had preoperative evaluations with a cardiac stress test ordered by a perioperative anesthesiologist. Of those, a total of 170 charts were identified as having a preoperative evaluation note and an exercise cardiac stress test. The METs of the patient estimated by history and the METs quantified by the exercise cardiac stress test were compared using a Bland–Altman plot and Cohen’s kappa. Results. Exercise cardiac stress test quantified METs were on average 3.3 METS higher than the METs estimated by the preoperative evaluation history. Only 9% of patients had lower METs quantified by the cardiac stress test than by history. Conclusions. The METs of a patient estimated by preoperative history often underestimates the METs measured by exercise stress testing. This demonstrates that the preoperative assessments of patients’ METs are often conservative which errs on the side of patient safety as it lowers the threshold for deciding to order further cardiac stress testing for screening for ischemia or cardiac failure.

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Prognostic Significance of Dyspnea in Patients Referred for Cardiac Stress Testing

New England Journal of Medicine ◽

10.1056/nejmoa042741 ◽

2005 ◽

Vol 353 (18) ◽

pp. 1889-1898 ◽

Cited By ~ 171

Author(s):

Aiden Abidov ◽

Alan Rozanski ◽

Rory Hachamovitch ◽

Sean W. Hayes ◽

Fatma Aboul-Enein ◽

...

Keyword(s):

Stress Testing ◽

Prognostic Significance ◽

Cardiac Stress ◽

Cardiac Stress Testing

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Role of Head and Cardiac Imaging, and Cardiac Stress Testing for Syncope

Syncope ◽

10.1007/978-3-030-44507-2_18 ◽

2020 ◽

pp. 221-225

Author(s):

Mohammed Ruzieh ◽

Blair P. Grubb

Keyword(s):

Cardiac Imaging ◽

Stress Testing ◽

Cardiac Stress ◽

Cardiac Stress Testing

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The Limited Utility of Routine Cardiac Stress Testing in Emergency Department Chest Pain Patients Younger Than 40 Years

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2009.01.006 ◽

2009 ◽

Vol 54 (1) ◽

pp. 12-16 ◽

Cited By ~ 45

Author(s):

Luke K. Hermann ◽

Scott D. Weingart ◽

W. Lane Duvall ◽

Milena J. Henzlova

Keyword(s):

Emergency Department ◽

Chest Pain ◽

Stress Testing ◽

Cardiac Stress ◽

Cardiac Stress Testing ◽

Pain Patients

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Blood pressure and risk of cognitive impairment. The role of vascular disease in neurodegeneration.

10.21203/rs.2.18666/v1 ◽

2019 ◽

Author(s):

Mar Carmona-Abellan ◽

Malwina Trzeciak ◽

Miriam Recio-Fernandez ◽

Beatriz Echeveste ◽

Laura Imaz ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Cognitive Impairment ◽

Cognitive Decline ◽

Stress Testing ◽

Cardiovascular Response ◽

Stress Test ◽

Peak Exercise ◽

Cardiac Stress ◽

Cardiac Stress Testing

Abstract Background: Both cerebral vascular disorders and cognitive decline increase in incidence with age. The role of cerebral vascular disease and hemodynamic changes in the development of cognitive deficits is controversial. The objective of this study was to assess cardiovascular response during cardiac stress testing in neurologically asymptomatic individuals who developed cognitive impairment several years after the cardiac stress testing.Methods: This is a retrospective cohort study of patients who underwent cardiac stress testing between January 2001 and December 2010. Patients were followed up until May 2015 and we selected those who developed cognitive dysfunction including dementia, mild cognitive impairment and subjective cognitive decline, after the stress test. Heart rate and blood pressure both at rest and at peak exercise and the mean R-R interval at rest were recorded. For each patient who developed cognitive impairment, we selected one matched control who did not show cognitive decline by the end of the follow-up period.Results: From this cohort of 7224 patients, 371 developed cognitive impairment; of these, 186 (124 men) met the inclusion criteria and 186 of the other patients were selected as matched controls. During follow-up, cognitive impairment appeared 6.2 ± 4.7 years after the cardiac stress test. These patients who subsequently developed cognitive impairment had significantly lower at-rest systolic, diastolic and mean blood pressure than controls (p<0.05). Further, compared with controls, their maximum heart rate was significantly higher at peak exercise and both systolic and diastolic blood pressures increased significantly more during exercise. Conclusion: The results from this study suggest that differences in cardiovascular response to stress are present in the preclinical phase of cognitive decline, serving as a potential risk factor for cognitive impairment. These findings challenge the potential use of blood pressure and heart rate variability at rest and during cardiac stress assessment as a risk factor for cognitive impairment.

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