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Research ArticleOriginal Research

Implications of Sociodemographic and Clinical Factors Associated with Completion of Cardiac Stress Tests

Maelys J. Amat, Anthony Zhong, Cancan Zhang, Ernest Gervino, Rishi Wadhera and Russell S. Phillips
The Journal of the American Board of Family Medicine November 2024, 37 (6) 1088-1094; DOI: https://doi.org/10.3122/jabfm.2024.240067R1
Maelys J. Amat
From the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA (MJA, CZ, RSP); Center for Primary Care, Harvard Medical School, Boston, MA (AZ, RSP); Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (EG, RW).
MD, MBA
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Anthony Zhong
From the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA (MJA, CZ, RSP); Center for Primary Care, Harvard Medical School, Boston, MA (AZ, RSP); Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (EG, RW).
MA
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Cancan Zhang
From the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA (MJA, CZ, RSP); Center for Primary Care, Harvard Medical School, Boston, MA (AZ, RSP); Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (EG, RW).
PhD
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Ernest Gervino
From the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA (MJA, CZ, RSP); Center for Primary Care, Harvard Medical School, Boston, MA (AZ, RSP); Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (EG, RW).
Sc.D
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Rishi Wadhera
From the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA (MJA, CZ, RSP); Center for Primary Care, Harvard Medical School, Boston, MA (AZ, RSP); Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (EG, RW).
MD, MPP, M.Phil
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Russell S. Phillips
From the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA (MJA, CZ, RSP); Center for Primary Care, Harvard Medical School, Boston, MA (AZ, RSP); Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (EG, RW).
MD
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Article Figures & Data

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    Table 1.

    Baseline Characteristics

    VariableIncomplete Tests (n = 50)Completed Tests (n = 100)P value
    Age (median, IQR)64 (54, 69)57.5 (52, 65)0.04
    Female gender (%)35 (70%)51 (51%)0.01
    Black race (%)28 (56%)31 (31%)0.02
    Non-English language (%)0 (0%)17 (17%)0.00
    Social vulnerability: RPL overall (median)0.71 (0.35, 0.93)0.46 (0.26, 0.78)0.01
    RPL theme 1 (median, IQR)0.67 (0.25, 0.84)0.36 (0.11, 0.70)0.01
    RPL theme 2 (median, IQR)0.70 (0.34, 0.91)0.39 (0.15, 0.76)0.01
    RPL theme 3 (median, IQR)0.66 (0.42, 0.91)0.59 (0.41, 0.79)0.19
    RPL theme 4 (median, IQR)0.73 (0.55, 0.84)0.67 (0.48, 0.82)0.25
    Diabetes (%)15 (30%)16 (16%)0.08
    Hypertension (%)36 (72%)64 (64%)0.16
    Dyslipidemia (%)41 (82%)68 (68%)0.02
    ASCVD score (median, IQR)10.4 (5.9, 18.3)7.8 (3.5, 12.7)0.07
    Pretest probability of CAD (median, IQR)0.08 (0.03, 0.16)0.11 (0.03, 0.18)0.46
    • Abbreviations: IQR, Interquartile Range; RPL, Recurrent Pregnancy Loss; ASCVD, Atherosclerotic Cardiovascular Disease; CAD, Coronary Artery Disease.

    • View popup
    Table 2.

    Univariate Analysis for Loop Closure

    VariableOdds Ratio, 95% CIP value
    Age0.97 (0.93,1.00)0.07
    Female gender0.38 (0.18,0.83)0.02
    Black race0.35 (0.16, 0.74)0.01
    Non-English language24995066 (0, inf)0.99
    Social vulnerability: RPL overall0.21 (0.06, 0.70)0.01
    RPL theme 10.23 (0.07, 0.74)0.01
    RPL theme 20.23 (0.08, 0.70)0.01
    RPL theme 30.40 (0.10, 1.59)0.19
    RPL theme 40.50 (0.12, 2.09)0.34
    Diabetes0.44 (0.19, 1.03)0.06
    Hypertension0.60 (0.27, 1.35)0.21
    Dyslipidemia0.35 (0.13, 0.93)0.04
    ASCVD score0.98 (0.95, 1.01)0.19
    Pretest probability of CAD1.57 (0.03, 75.43)0.82
    • Abbreviations: CI, Confidence Interval; RPL, Recurrent Pregnancy Loss; ASCVD, Atherosclerotic Cardiovascular Disease; CAD, Coronary Artery Disease; INF, Infarction.

    • View popup
    Table 3.

    Cox Model for Loop Closure

    VariablesOdds Ratio, 95% CIP value
    Age0.97 (0.93, 1.01)0.10
    Female gender0.43 (0.18, 1.00)0.05
    Black race0.26 (0.11, 0.61)0.00
    Dyslipidemia0.27 (0.09, 0.78)0.02
    • * Adjusted for all covariates including age, gender, race, language, social vulnerability, ASCVD risk score, pretest probability of CAD and diagnoses of diabetes, hypertension, dyslipidemia.

    • Abbreviations: CI, Confidence Interval; ASCVD, Atherosclerotic Cardiovascular Disease; CAD, Coronary Artery Disease.

    • View popup
    Table 4.

    Univariate Analysis for Time to Loop Closure

    VariableHazard Ratio, 95% CIP value
    Age0.98 (0.96,1.00)0.12
    Female gender0.66 (0.44,0.99)0.04
    Black race0.49 (0.31, 0.77)0.00
    Non-English language2.23 (1.27, 3.94)0.01
    Social vulnerability: RPL overall0.41 (0.21, 0.78)0.01
    RPL theme 10.41 (0.21, 0.78)0.01
    RPL theme 20.39 (0.21, 0.71)0.00
    RPL theme 30.49 (0.24, 1.03)0.06
    RPL theme 40.72 (0.33, 1.58)0.41
    Diabetes0.57 (0.33, 1.00)0.05
    Hypertension0.64 (0.42, 0.99)0.05
    Dyslipidemia0.58 (0.37, 0.91)0.02
    ASCVD score0.99 (0.96, 1.01)0.19
    Pretest probability of CAD1.36 (0.15, 12.04)0.78
    • Abbreviations: CI, Confidence Interval; RPL, Recurrent Pregnancy Loss; ASCVD, Atherosclerotic Cardiovascular Disease; CAD, Coronary Artery Disease.

    • View popup
    Table 5.

    Cox Model for Time to Loop Closure

    VariablesHazard Ratio, 95% CIP value
    Age0.98 (0.96, 1.00)0.10
    Female gender0.69 (0.44, 1.09)0.11
    Black race0.51 (0.31, 0.85)0.01
    Non-English language2.66 (1.47, 4.84)0.00
    RPL theme 20.54 (0.27, 1.09)0.09
    Diabetes0.64 (0.36, 1.13)0.12
    Dyslipidemia0.46 (0.28, 0.77)0.00
    • * Adjusted for all covariates including age, gender, race, language, social vulnerability, ASCVD risk score, pretest probability of CAD and diagnoses of diabetes, hypertension, dyslipidemia.

    • Abbreviations: CI, Confidence Interval; ASCVD, Atherosclerotic Cardiovascular Disease; CAD, Coronary Artery Disease; RPL, Recurrent Pregnancy Loss.

    • View popup
    Table 6.

    Association of Test Completion with PreTest Probability of Coronary Artery Disease (CAD)

    Completed On TimeDelayedIncomplete
    Low risk (0 to 5%)30%22%34%
    Intermediate risk (6 to 14%)58%72%58%
    High risk (>=15%)12%6%8%
    • * Risk was determined based on European Society of Cardiology model, an expanded version of the Diamond and Forrester scoring system which incorporates age, gender, and chest pain quality (divided into 3 categories: typical, atypical and non-anginal).

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The Journal of the American Board of Family     Medicine: 37 (6)
The Journal of the American Board of Family Medicine
Vol. 37, Issue 6
November-December 2024
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Implications of Sociodemographic and Clinical Factors Associated with Completion of Cardiac Stress Tests
Maelys J. Amat, Anthony Zhong, Cancan Zhang, Ernest Gervino, Rishi Wadhera, Russell S. Phillips
The Journal of the American Board of Family Medicine Nov 2024, 37 (6) 1088-1094; DOI: 10.3122/jabfm.2024.240067R1

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Implications of Sociodemographic and Clinical Factors Associated with Completion of Cardiac Stress Tests
Maelys J. Amat, Anthony Zhong, Cancan Zhang, Ernest Gervino, Rishi Wadhera, Russell S. Phillips
The Journal of the American Board of Family Medicine Nov 2024, 37 (6) 1088-1094; DOI: 10.3122/jabfm.2024.240067R1
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Keywords

  • Academic Medical Centers
  • Diagnostic Errors
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  • Patient Safety
  • Primary Health Care
  • Quality Improvement
  • Retrospective Studies
  • Sociodemographic Factors
  • Cardiac Stress Test

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