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Needless worry often caused by exercise tests.

The American ideal of a long and active life has led many to seek guarantees of future health and fitness. People with no outward sign of ill health clamor for tests to affirm that they are sound of body and seek methods to make certain they stay that way. For years, those concerned about coronary artery disease have sought peace of mind by taking a relatively inexpensive and non-invasive stress test. But, despite its increasing use, doctors have begun to question whether the treadmill actually does patients more harm than good.

The reason, experts say, is the test's unreliability in patients who exhibit no outward symptoms of coronary artery disease. Too often, a single false-positive result on a stress test will lead to emotional distress and financial hardship. Patients undergo torturous follow-up tests seeking a disease that isn't there.

Dr. Victor Froelicher, chief of cardiology at Long Beach Veterans Affairs Medical Center in California, estimated that of 20 patients with no apparent symptoms and showing an abnormal stress test, at least one will have a heart attack in five to eight years. "If you take a group of low-risk people and exercise-test them, you're going to have more false-positives than true positives," said Dr. David Pryor, associate professor of medicine at Duke University.

Then why do the test? Many physicians use it in a genuine attempt to determine a patient's risk of coronary disease and anticipate possible problems. Others employ the treadmill as defensive medicine, fearful of malpractice suits.

Policy decisions by the Social Security Administration and the Blue Cross and Blue Shield Association, however, are encouraging more doctors to administer preventive stress tests to such patients.

Many of the best-intentioned physicians do not know how to read the test results. "Perhaps 10% of the doctors who perform exercise tests are fully informed about the stress test's unreliability," said Dr. Myrvin Ellestad, medical director of the Memorial Heart Institute in Long Beach, Calif. By itself, a positive result on a stress test is meaningless; only by taking into account such factors as gender, age, serum cholesterol, blood pressure and whether a patient smokes, has diabetes or has a family history of coronary artery disease can a physician reasonabaly determine probable risk.

Guidelines published in 1986 by the American College of Cardiology and the American Heart Association consider stress testing of questionable value even in men over 40 who exhibit two of the above risk factors.

Test results can also be ambiguous. For example, an abnormality may be significant or moot depending on when, during the test, it occurs and at which heart rate. Recovery time, too, can be interpreted in a variety of ways.

Several reference guides are being developed to help doctors evaluate stress tests more accurately. A revised American Heart Association "Coronary Risk Factor Handbook" and a computer program called Cadenza, devised by Dr. George Diamond of Cedars-Sinai Medical Center in Los Angeles, computes a patient's risk factor with greater accuracy and calculates probability of disease.

Says Dr. Pryor, "Generally, there's little to gain from the indiscriminant use of exercise testing in low-risk people."
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Title Annotation:false positive results may lead to emotional distress and financial hardship
Publication:Nutrition Health Review
Date:Jan 1, 1991
Words:516
Previous Article:Drug effects on elderly differ from younger adults.
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