Prognostic Value of Treadmill Exercise Testing in Elderly Persons

  1. Tauqir Y. Goraya, MD, PhD;
  2. Steven J. Jacobsen, MD, PhD;
  3. Patricia A. Pellikka, MD;
  4. Todd D. Miller, MD;
  5. Akbar Khan;
  6. Susan A. Weston, MS;
  7. Bernard J. Gersh, MB, ChB, DPhil; and
  8. Véronique L. Roger, MD, MPH
  1. From the Mayo Clinic and Mayo Foundation, Rochester, Minnesota.

    Abstract

    Background: Recent exercise testing guidelines recognized a gap in knowledge about the prognostic value of treadmill exercise testing in elderly persons.

    Objective: To test the hypothesis that treadmill exercise testing has equal prognostic value among elderly (≥ 65 years of age) and younger (<65 years of age) persons and to examine the incremental value of this testing over clinical data.

    Design: Inception cohort with a median follow-up of 6 years.

    Setting: Olmsted County, Minnesota.

    Patients: All elderly (n = 514) and younger (n = 2593) residents of Olmsted County who underwent treadmill exercise testing between 1987 and 1989.

    Measurements: Overall mortality and cardiac events (cardiac death, nonfatal myocardial infarction, and congestive heart failure).

    Results: Compared with younger patients, elderly patients had more comorbid conditions, achieved a lower workload (6.0 and 10.7 metabolic equivalents; P < 0.001), and had a greater likelihood of a positive exercise electrocardiogram (28% and 9%; P < 0.001). With median follow-up of 6 years, overall survival (63% and 92%; P < 0.001) and cardiac event–free survival (66% and 95%; P < 0.001) were worse among elderly persons than among younger persons. Workload was the only treadmill exercise testing variable associated with all-cause mortality in both age groups, and the strength of association was similar. Workload and angina with exercise testing were associated with cardiac events in both age groups, whereas a positive exercise electrocardiogram was associated with cardiac events only in younger persons (P < 0.05 for all comparisons). After adjustment for clinical variables, workload was the only additional treadmill exercise testing variable that was predictive of death (P < 0.001) and cardiac events (P < 0.05); the strength of the association was similar in both age groups. Each 1–metabolic equivalent increase in exercise capacity was associated with a 14% and 18% reduction in cardiac events among younger and elderly persons, respectively.

    Conclusions: In elderly persons, treadmill exercise testing provided prognostic information that is incremental to clinical data. After adjustment for clinical factors, workload was the only treadmill exercise testing variable that was strongly associated with outcome, and its prognostic effect was of the same magnitude in elderly and younger persons.

    Article and Author Information

    • Acknowledgments: The authors thank Jeannie Hill and Susan Stotz for assistance with data collection, Jill Killian and Erin Green for assistance with statistical analysis, and Kristie Shorter for secretarial assistance.

    • Grant Support: In part by research grants from the American Heart Association National Center (93-1325 and 96-1358) and a grant from the Public Health Service, National Institutes of Health (AR30582).

    • Requests for Single Reprints: Tauqir Y. Goraya, MD, PhD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

    • Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.

    • Current Author Addresses: Drs. Goraya, Pellikka, Miller, Gersh, and Roger: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

    • Dr. Jacobsen: Section of Clinical Epidemiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

    • Mr. Khan: Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112-2699.

    • Ms. Weston: Section of Biostatistics, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

    • Author Contributions: Conception and design: T.Y. Goraya, S.J. Jacobsen, V.L. Roger.

    • Analysis and interpretation of the data: T.Y. Goraya, S.J. Jacobsen, P.A. Pellikka, T.D. Miller, B.J. Gersh, V.L. Roger.

    • Drafting of the article: T.Y. Goraya, S.J. Jacobsen, V.L. Roger.

    • Critical revision of the article for important intellectual content: T.Y. Goraya, S.J. Jacobsen, P.A. Pellikka, T.D. Miller, B.J. Gersh, V.L. Roger.

    • Final approval of the article: T.Y. Goraya, S.J. Jacobsen, A. Khan, V.L. Roger.

    • Provision of study materials or patients: P.A. Pellikka, T.D. Miller, B.J. Gersh, V.L. Roger.

    • Statistical expertise: T.Y. Goraya, S.J. Jacobsen, S.A. Weston, V.L. Roger.

    • Obtaining of funding: V.L. Roger.

    • Administrative, technical, or logistic support: A. Khan, V.L. Roger.

    • Collection and assembly of data: T.Y. Goraya, A. Khan, V.L. Roger.

    Summary for Patients

    « Previous | Next Article »Table of Contents

    This Article

    1. Ann Intern Med June 6, 2000 vol. 132 no. 11 862-870
    1. » Abstract
    2. Figures
    3. Full Text
    4. Full Text (PDF)
      1. Summary for Patients

    Rapid Responses

    1. Submit a response
    2. No responses published

    Current Issue

    1. February 2, 2010, 152 (3)
    1. Alert me to current issues