Selection of Patients for Exercise Stress Testing in a Primary Care Setting
| ACC/AHA Class | |
|---|---|
| 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 therapy† | I |
| 5. Evaluating patients after MI for risk stratification† | I |
| 6. Establishing severity and prognosis of CAD –Duke Score assessment† | I |
| 7. Evaluating dysrhythmias | II |
| 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 complications | IIA |
| 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 factors | IIB |
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.