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Exercise Testing in Patients 65 Years of Age and Older
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What is the problem and what is known about it so far?
Exercise tests record symptoms and the electrical activity of the heart while patients exercise, usually on a treadmill. These tests are very helpful in finding out whether a person has heart disease and in predicting who is at risk for future heart-related problems, like heart attacks. Because previous research on exercise tests has included few elderly patients, it is unclear how useful these tests are in persons 65 years of age or older.
Why did the researchers do this particular study?
To find out whether exercise testing predicts heart-related problems (heart attacks, heart failure, and death) in persons 65 years of age or older as well as it does in persons younger than 65 years.
Who was studied?
The study included all 514 older (>65 years of age) and all 2593 younger (<65 years of age) residents of Olmstead County, Minnesota who had an exercise test between 1987 and 1989.
How was the study done?
The researchers examined the results of exercise tests and determined which patients had later died or had a heart attack or heart failure. They then measured how well the exercise testing predicted these cardiac events in older patients compared with younger patients. The test results studied were workload and electrocardiographic changes. Workload measures how long and hard a person is able to exercise during the test. Electrocardiographic changes are abnormalities in electrical activity of the heart.
What did the researchers find?
Older patients could not exercise as hard as younger patients and were more likely to have abnormalities in the electrical activity of the heart during an exercise test. Six years after the test, 92% of younger patients and 63% of older patients were alive. In addition, 95% of younger patients had had no heart attack, heart-related death, or heart failure compared with only 66% of the older patients. Workload was the only measure that predicted bad heart-related events. The relation between workload and outcome was similar in older and younger patients, even after accounting for other risk factors for heart disease such as smoking and cholesterol levels.
What were the limitations of the study?
Most of the study participants were white, and most had no symptoms of heart disease at the time of the test. The results might be different in ethnically diverse populations or in persons who initially had symptoms that were consistent with heart disease. In addition, all of the study participants had been selected by their physicians to have exercise testing. Patients who are referred by their doctors for testing may be more likely to have underlying heart disease than those who are not referred for testing.
What are the implications of the study?
Workload, as measured by exercise treadmill testing, helped to predict survival and bad heart-related events in both younger and older patients.
Article and Author Information
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The summary below is from the full report titled “Prognostic Value of Treadmill Exercise Testing in Elderly Persons.” It is in the 6 June 2000 issue of Annals of Internal Medicine (volume 132, pages 862-870). The authors are T.Y. Goraya, S.J. Jacobsen, P.A. Pellikka, T.D. Miller, A. Khan, S.A. Weston, B.J. Gersh, and V.L. Roger.
- Copyright ©2004 by the American College of Physicians
