Stress testing in the evaluation of patients suspected of having coronary heart disease
It has been recognized for some time that of the 600,000 people who die of coronary heart disease each year, about 350,000 die suddenly, apparently without prior warning. Hundreds of thousands of men of susceptible age group probably go to their private physicians each year or intermittently for a checkup. They go either because they believe some latent disease might be discovered at examination or because of symptoms that they may often fail to relate to their physicians. This is either because of fear of what they might find or because of misinterpretation of the signs.
Risk factor testing is so routine in such a clinical setting that its omission might well be grounds for malpractice. The American Heart Association handbook depicting the risk factors derived from the Framingham study is the standard used. The estimation of the patient’s risk by this type of evaluation is useful in enlisting his cooperation when a change in life-style seems indicated. In such a situation is it legitimate for the doctor to withhold a test which has been demonstrated to have the highest predictive value? The stress test, when positive, will be associated with some coronary event in 5 years in about 60% of the subjects. This finding is not only present in our data, but in follow-up studies from other laboratories. All other risk factors yet published have a lesser sensitivity. Although a significant number of subjects with positive stress tests do not have significant obstruction in their coronary arteries and a . . .