Key result
Technician-supervised treadmill testing achieves similar diagnostic yield to doctor-supervised testing despite lower peak workload.
Why the study?
The efficacy and safety of trained cardiac technicians independently performing treadmill exercise stress tests in patients with suspected angina pectoris needed to be determined.
Does independent supervision of treadmill exercise stress tests by trained cardiac technicians provide comparable diagnostic efficacy and safety to supervision by doctors in patients with suspected angina pectoris?
Cohort (n=475)
No
Does independent supervision of treadmill exercise stress tests by trained cardiac technicians provide comparable diagnostic efficacy and safety to supervision by doctors in patients with suspected angina pectoris?
Trained cardiac technicians can independently supervise treadmill exercise stress tests in chest pain clinics with comparable diagnostic yield and low complication rates relative to physicians.
Answers are grounded in this paper and cite their sources.
Technician-led stress testing may be feasible in select settings; leaves open whether accuracy and safety match specialists in routine practice.
OBJECTIVE: To determine the efficacy and safety of trained cardiac technicians independently performing treadmill exercise stress tests as part of the assessment of patients with suspected angina pectoris. DESIGN: Retrospective comparison of 250 exercise tests performed by cardiac technicians and 225 tests performed by experienced cardiology clinical assistants (general practitioners who perform regular NHS cardiology duties), and consultant cardiologists over the same time period. SETTING: Regional cardiac centre with a dedicated cardiac chest pain clinic. PATIENTS: All patients were referred by their general practitioners with a history of recent onset of chest pain, which was suspected to be angina pectoris. OUTCOME MEASURES: Peak workload achieved, symptoms, indications for termination, complications. RESULTS: The diagnostic yield of technician supervised tests (percentage positive or negative) was similar to that of medically supervised tests (76% v 69%, NS). The average peak workload achieved by patients was less by 1.2 mets (p < 0.005). This was probably due to more tests being terminated earlier due to chest pain and ST segment depression in the technician group compared with doctors (10% and 16% v 5% and 11% respectively, p = 0.06 and 0.07). One patient in the technician supervised group developed a supraventricular tachycardia during the recovery phase of the exercise test. CONCLUSIONS: Technician supervised stress testing is associated with a high diagnostic rate and low complication rate in patients with suspected ischaemic heart disease. Its efficacy is comparable to tests supervised by experienced doctors and its use should be encouraged.
No takes yet. Share an insight, caveat, or question.
Davis et al. (1998) conducted a cohort in Suspected angina pectoris / recent onset of chest pain (n=475). Technician-supervised treadmill exercise stress testing vs. Physician-supervised treadmill exercise stress testing (cardiology clinical assistants and consultant cardiologists) was evaluated on Diagnostic yield (percentage positive or negative) (p=NS). Technician-supervised treadmill exercise testing achieved a diagnostic yield similar to doctor-supervised testing (76% vs 69%, NS), though average peak workload was 1.2 METs lower (p<0.005).
Synapse has enriched 10 related papers. Consider them for comparative context: