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Am Fam Physician. 2006;73(6):1111-1112

The Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention of the American Heart Association (AHA) has released a scientific statement on exercise testing to screen asymptomatic patients for disease. The full report was published in the August 2, 2005, issue of Circulation and is available online athttp://circ.ahajournals.org/cgi/content/full/112/5/771.

Exercise testing has been considered an inexpensive, convenient, and safe way to screen asymptomatic patients for disease. However, data have shown that this modality may be inaccurate, even in symptomatic patients. This led the U.S. Preventive Services Task Force to recommend against using exercise testing as a routine screening tool. These data may be attributable to the limitations of the ST segment for diagnosing coronary disease in asymptomatic patients. In the report, the AHA subcommittee analyzes the role of exercise testing as a prognostic tool, focusing on nonelectrocardiographic measures (e.g., functional capacity, chronotropic response, heart rate recovery, ventricular ectopy).

Although the AHA subcommittee found data to suggest that nonelectrocardiographic measures can predict adverse events in asymptomatic patients, there is no evidence to suggest that exercise testing improves outcomes. The subcommittee concludes that there is insufficient evidence to recommend exercise testing as a routine screening tool in asymptomatic adults. However, the AHA subcommittee says that the prognostic capabilities of exercise testing warrant a large-scale randomized trial to evaluate how it affects outcomes.

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