A survey of diagnostic stress testing centers in New York City

Exercise electrocardiography (ECG) is widely employed for diagnosis of coronary heart disease (CHD) and for assessment of aerobic fitness prior to starting an exercise training program. This study surveyed stress testing centers in New York City (NYC) to determine practices currently used and to compare these practices with those suggested by the American Heart Association (AHA). A questionnaire was sent to 46 known centers in New York City and 18 responded. Of these, two did not list diagnosis of CHD as one of their purposes and were excluded from the sample, thus leaving 16 to be considered for this report. The most noteworthy findings were: most tests (56%) are conducted on asymptomatic adults, a population in whom the sensitivity and specificity of exercise ECG is relatively poor; only four centers employed qualified exercise physiologists, the profession specifically trained to perform fitness testing and exercise prescription for asymptomatic adults; over 50% of the centers terminate the test in the absence of symptoms when the client reaches a heart rate of 75%-95% of age-predicted maximal, even though maximal testing is suggested by the AHA; most centers did not include submaximal physiological responses in their test reports to clients and referring physicians; and most centers did not have a clearly established plan for handling emergencies. By bringing their practices into closer agreement with recommendations of appropriate professional organizations, testing centers can probably enhance the effectiveness and safety of their services to the public.