When to Use Exercise Testing—Indications, Guidelines and Appropriate Use Criteria

Abstract

The chapter When to Use Exercise Testing—Indications, Guidelines, and Appropriate Use Criteria (AUC) reviews and interprets the American College of Cardiology and American Heart Association guidelines and AUC. Exercise testing remains the cornerstone of the evaluation of coronary artery disease (CAD) in patients whose electrocardiogram is interpretable for ischemia and who are expected to be able to achieve ≥85% maximum predicted heart rate with exercise. If either is not the case, or if greater test sensitivity is clinically necessary, pharmacologic testing with myocardial perfusion imaging (MPI) or stress echocardiography is indicated. The Duke Activity Status Index (DASI) score can be used as a tool to determine to predict if a patient can perform the recommended ≥5 metabolic equivalents (METs) on an exercise test. The HEART score can be effectively used to determine low risk patients presenting to the emergency room with chest pain can be safely discharged for outpatient evaluation.