Objective: To determine the utility of exercise electrocardiography testing (EET) in evaluating suspected coronary artery disease in a remote Australian setting where a significant proportion of patients are Indigenous Australians.
Patients and setting: 268 patients with suspected coronary artery disease who underwent EET at Alice Springs Hospital — a specialist teaching hospital in Central Australia with no resident specialist cardiology service — in the period 1 June 2009 to 31 May 2010.
Results: Indigenous patients were younger, more likely to be women and were twice as likely as non-Indigenous patients to have a chronic disease. Indigenous patients and those with a chronic disease had a higher proportion of inconclusive results. Completed EET had a positive predictive value of 48.1% (95% CI, 28.7%–68.1%) and a negative predictive value of 96.5% (95% CI, 93.2%–98.5%). Similar results were seen among Indigenous and non-Indigenous patients.
Conclusions: In regional and remote Australian settings, EET remains an important tool for the diagnosis of coronary artery disease. It is useful, and is reassuring to patients and clinicians if the result is negative, particularly in a remote Indigenous Australian population with a significant burden of cardiovascular risk.
- 1. Australian Bureau of Statistics. Causes of death, Australia, 2010. Canberra: ABS, 2010. (ABS Cat. No. 3303.0.) http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3303.02010?Open Document (accessed Feb 2013).
- 2. Mathur S, Moon L, Leigh S. Aboriginal and Torres Strait Islander people with coronary heart disease: further perspectives on health status and treatment. Canberra: Australian Institute of Health and Welfare, 2006. (AIHW Cat. No. CVD 33; Cardiovascular Disease Series No. 25.) http://www.aihw.gov.au/publication-detail/?id=6442467898 (accessed Feb 2013).
- 3. Penm E. Cardiovascular disease and its associated risk factors in Aboriginal and Torres Strait Islander peoples 2004–05. Canberra: Australian Institute of Health and Welfare, 2008. (AIHW Cat. No. CVD 41.) http://www.aihw.gov. au/publication-detail/?id=6442468095 (accessed Feb 2013).
- 4. Zhao Y, Dempsey K. Causes of inequality in life expectancy between Indigenous and non-Indigenous people in the Northern Territory, 1981-2000: a decomposition analysis. Med J Aust 2006; 184: 490-494. <MJA full text>
- 5. Garber AM, Solomon NA. Cost-effectiveness of alternative test strategies for the diagnosis of coronary artery disease. Ann Intern Med 1999; 130: 719-728.
- 6. Australian Bureau of Statistics. Population distribution, Aboriginal and Torres Strait Islander Australians, 2006. Canberra: ABS, 2007. (ABS Cat. No. 4705.0.) http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4705.02006?OpenDocument (accessed Feb 2013).
- 7. Banerjee A, Newman DR, Van den Bruel A, Heneghan C. Diagnostic accuracy of exercise stress testing for coronary artery disease: a systematic review and meta-analysis of prospective studies. Int J Clin Pract 2012; 66: 477-492.
- 8. Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation 2002; 106: 1883-1892.
- 9. Peterson PN, Magid DJ, Ross C, et al. Association of exercise capacity on treadmill with future cardiac events in patients referred for exercise testing. Arch Intern Med 2008; 168: 174-179.
- 10. Hill J, Timmis A. Exercise tolerance testing. BMJ 2002; 324: 1084-1087.
- 11. Newman RJ, Darrow M, Cummings DM, et al. Predictive value of exercise stress testing in a family medicine population. J Am Board Fam Med 2008; 21: 531-538.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.