A negative finding in an exercise test is reliable among elderly people: a follow-up study

Coronary heart disease (CHD) is very common among elderly people.

To specify the diagnostic value of bicycle exercise tests conducted for elderly patients by trained general practitioners in primary health care.

We performed a 2-year follow-up study at the Kangasala Health Centre, Finland. The study population comprised all patients at least 60 years old (n = 311) suspected of having CHD without prior diagnosis who were examined by an exercise test carried out by trained general practitioners during a period of 3 years. Specificity and sensitivity as well as positive and negative predictive values of the tests were calculated based on whether or not the participants had a diagnosis of CHD by the end of the follow-up period. The numbers of patients referred for coronary angiography and bypass operation were registered. For analysis, the patients were divided into two age categories: 60-69 years and >or=70 years.

A negative finding in the test proved very reliable: CHD manifested in only 3% of these cases in both age groups. The specificity of the test was 72% in the group 60-69 years and 66% in the group >or=70 years; the sensitivity values were 81 and 67%, respectively. The positive predictive values were 26 and 12%, the negative predictive value was 97% in both age groups. 1 in 4 patients yielding a positive finding eventually underwent coronary angiography and 1 in 6 patients coronary bypass surgery.

Exercise tests may predict the clinical outcome of CHD among elderly patients. A negative finding in an exercise test is very reliable.