Exercise Stress Tests

Abstract

Coronary heart disease is a leading cause of death in this country, and many people who die of heart attacks do not have any cardiac symptoms or diagnoses. Cardiac stress tests can theoretically detect silent heart disease that could lead to fewer cardiac deaths if treated. In fact, it is felt that 19 people out of 1,000 who have a positive stress test will have decreased cardiac events or death due to subsequent intervention. But, due to the high rate of false-positive tests, 20 people out of 1,000 tested will suffer harm from stress tests. Also, the vast majority of people who die of cardiac events would have a negative stress test, which is a very high false negative rate. Nevertheless, there continues to be confusion regarding the benefits of stress testing and subsequent risks associated with medical intervention. Information presented to doctors and patients tends to be misleading and difficult to interpret. This is due, in large part, to the use of relative risks rather than absolute values when communicating information on stress test benefits. In light of this situation, a unique graphic, functioning as a decision aid, has been developed to enable physicians and patients to jointly assess the benefits and risks of stress tests and eventual medical intervention. By addressing risks and benefits in terms patients can understand, doctors and their patients can better make well informed shared decisions about health interventions.