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16-02-2012 | Article

Exercise ECG benefits overlooked


BMJ Open 2012; 2: e000508

Researchers suggest that the exercise ECG should continue to be used in the assessment of patients with suspected angina, even though NICE has ruled it out for diagnosing the condition.

As reported in BMJ Open, the researchers evaluated the use of exercise ECGs in 89 consultations at three chest pain clinics. They found that the test helped to engage patients in the diagnostic process and clarify their clinical history, as well as providing an opportunity to advise on reducing cardiovascular risk.

Dr Helen Cramer and colleagues from the University of Bristol told GP News: "Performing the exercise ECG gives patients an active physical role in the assessment process which GPs can reinforce in the community, with recommendations about physical activity and fitness."

The exercise ECG was particularly useful in reassuring patients with a negative test. "There is no other test that could give them the confidence to go out and exercise without fear, as other tests are conducted by a technician in a different space," the researchers noted.

The treadmill test also gave clinicians a context in which to recommend increases in exercise, as well as changes in diet and smoking cessation. Indeed, the team explained, the exercise ECG can demonstrate to patients "appropriate levels of exercise and the amount of breathlessness they should be experiencing to improve their fitness".

Dr Cramer commented: "As chest pain clinic services are reconfigured without the test, in line with NICE guidance, the exercise ECG will have a diminishing role in the diagnosis of angina. However, many of the practices that have been built up around the use of exercise ECG are potentially beneficial to patients and need to be considered in the redesign of chest pain assessment services without that test."

GP News is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

By Caroline Price