EMBARGOED UNTIL: February 27, 1998
Rob Whitehouse
216-444-8927
Jim Armstrong
216-444-9455
CLEVELAND CLINIC STUDY IN THE LANCET SUPPORTS ROUTINE EXERCISE TESTING OF PATIENTS FOLLOWING BYPASS SURGERY
Routine performance of an exercise test among symptom-free patients who have had coronary artery bypass surgery can help identify those at risk for premature death and heart attack, Cleveland Clinic physicians reported in a study published in the February 28 issue of The Lancet.
Exercise testing on a treadmill is often done to identify patients who would benefit from coronary artery bypass surgery; however, the usefulness of exercise testing among those who have already had surgery has not been well studied. In fact, current professional practice guidelines in use throughout the United States specifically recommend against the routine use of exercise testing in the years following heart surgery.
"Although bypass surgery has been shown to reduce death rates in some patients with heart disease, many patients develop further blockages in coronary arteries and in bypass grafts after surgery, which can lead to premature death and heart attacks," said Cleveland Clinic cardiologist Michael S. Lauer, M.D., the study's principal investigator. "This study suggests that, with the use of proper screening protocols, routine exercise testing for this group of patients can be of great benefit without an undue financial burden on the healthcare system."
The study, conducted between 1990 and 1993, examined 873 patients who had undergone coronary bypass surgery and who subsequently experienced no angina or other major coronary events. Exercise testing using thallium-201 single-photon-emission computed tomography identified 508 patients (or 58 percent of the study population) with defects in the heart's blood flow.
During the three-year follow-up, patients with the blood flow defects were more likely to die or suffer a major cardiac event. Nine percent of the study patients with defects died, compared to 3 percent of those without the defects. Similarly, patients who had blood flow defects were more likely to suffer from heart attacks.
The study suggests exercise testing should be performed during the first six years following a coronary artery bypass -- although the earlier the better. Among those patients who had exercising testing within three years after bypass surgery, the presence of blood flow defects increased the risk of death or heart attack four- to five-fold. As nearly half a million Americans undergo bypass surgery every year, the authors estimate that millions of currently asymptomatic adults might stand to benefit from an exercise test.
"Certainly, some will debate the cost of routine exercise testing for such a large number of symptom-free patients. However, you have to consider that once symptoms arise, much more expensive diagnostic procedures and therapies are often required," said Dr. Lauer. "Identifying high-risk patients as early as possible may be quite beneficial and cost-effective. We were actually surprised at how low the cost is to identify patients at risk."
The Cleveland Clinic Foundation, founded in 1921, integrates clinical and hospital care with research and education in a private, non-profit group practice. Last year at the Cleveland Clinic and Cleveland Clinic Florida, over 850 full-time salaried physicians representing more than 100 medical specialties and subspecialties provided for 1,182,300 outpatient visits and 49,987 hospital admissions for patients from throughout the United States and more than 80 countries. In 1997, the Cleveland Clinic Health System C comprising The Cleveland Clinic Foundation and Fairview, Lakewood, Lutheran, Marymount, Meridia Euclid, Meridia Hillcrest, Meridia Huron and Meridia South Pointe hospitals C was formed. With 2,957 staffed beds, the Cleveland Clinic Health System offers broad geographic coverage, a full continuum of care, improved quality and lower cost of care to Northeast Ohio residents.
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