Table 4.

Selection of Patients for Exercise Stress Testing in a Primary Care Setting

1. Symptomatic patients—adults with chest pain with intermediate pretest probability of CAD (see Table 5)*I
2. Generating an exercise prescription
3. Determining functional capacity
4. Evaluating antianginal therapyI
5. Evaluating patients after MI for risk stratificationI
6. Establishing severity and prognosis of CAD –Duke Score assessmentI
7. Evaluating dysrhythmiasII
8. Asymptomatic patients (limited indications)
    A. Diabetics before starting moderate- to high-intensity exercise and age >35 years; type 2 DM for >10 years; type 1 DM for >15 years; presence of other cardiac risk factors, microvascular complications, or macrovascular complicationsIIA
    B. Men >45 years old, women >55 years old who plan to start a vigorous exercise program; high-risk public safety occupations; high risk for CAD with multiple other CAD risk factorsIIB
  • Modified from refs. 10 and 28.

  • * This is the most common indication.

  • Some primary care physicians may choose to refer these patients with known CAD for exercise sestamibi study.

  • ACC/AHA, American College of Cardiology/American Heart Association ; CAD, coronary artery disease; MI, myocardial infarction; DM, diabetes mellitus.