Neuropsychiatric symptoms during 24 hours after dobutamine-atropine stress testing: a prospective study in 1,006...

The aim of this study was to investigate the incidence and predictors of neuropsychiatric (NP) symptoms during 24 hours after dobutamine-atropine stress testing (DST).

Consecutive outpatients undergoing DST were asked to return a questionnaire regarding symptoms during the following 24 hours. Trained registered nurses administered the Delirium Observation Screening Scale before and after DST. To assess baseline symptoms in a control group, consecutive patients referred for DST completed the questionnaire regarding their symptoms during the 24 hours before DST.

A total of 1,006 patients were included (mean age, 67 ± 12 years; 462 [46%] women). Of the 750 patients who returned questionnaires, 53 patients (7.1%) reported NP symptoms. Among the 199 controls, three patients (1.5%) reported NP symptoms. Symptoms were usually mild and resolved spontaneously. Independent predictors of NP symptoms were atropine dose ≥ 1 mg (odds ratio [OR], 7.69; 95% confidence interval [CI], 4.13-14.81), prior NP disorder (OR, 2.11; 95% CI, 1.11-4.02), positive Delirium Observation Screening Scale result (OR, 4.89; 95% CI, 1.21-18.09), and body mass index < 24 kg/m(2) (OR, 2.37; 95% CI, 1.10-4.90).

Although usually mild, NP symptoms were nearly fivefold more common after DST (P < .001). Patients who had received ≥ 1 mg atropine and those with underlying NP disease, positive Delirium Observation Screening Scale results, or lower body mass indexes are at increased risk.