Cardiac Stress Test Algorithm for Primary Care Providers

Through the efforts of COMDC, Central Ohio Health Plans have endorsed a common stress-testing algorithm for Coronary Artery Disease. We understand the diagnosis of CAD can be difficult. The information we reviewed is taken from the AHA, AMA and the ASNC (American Society of Nuclear Cardiology) guidelines. Stress ECG is recom-mended for patients with a normal resting ECG and a low probability of CAD. If there are baseline ECG abnormalities (>1mm ST segment depression, LBBB, digitalis effect, ventricular paced rhythm, or ventricular pre-excitation (Wolff-Parkinson-White), stress imaging is required. Stress imaging is also preferred as the initial test in patients with known CAD (prior MI or revascularization). If dyspnea is a predominant symptom or if an assessment of valvular disease is desired, stress echocardiography is preferred. For patients with anticipated poor acoustic windows for echocardiography (COPD, obesity) nuclear perfusion imaging is preferred.

Click here for the pocket guidelines as well as patient information sheets for you to distribute to your patients who will be receiving one of these studies. The patient information sheet will be available on the COMDC web-site @ www.COMDC.org should you wish to download and reformat with the logo of your practice. Diagnostic Test Form