title: Strategies for risk evaluation of sudden cardiac incapacitation in men in occupations affecting public safety.
abstract: Sudden cardiac incapacitation occurring during critically stressful circumstances in men engaged in a variety of occupations may compromise public safety. Since the primary cause of this incapacitation is usually heart disease, more effective medical screening has been advocated. We report the annual incidence of sudden cardiac incapacitation in four clinical groups--4105 healthy men (Group I), 537 men with atypical chest pain syndromes (Group II), 1374 hypertensive men (Group III), and 2373 men with clinically manifest coronary heart disease (Group IV)--who have been examined and tested by maximal exercise with the Bruce protocol in Seattle community practice. Five strategies for prospective risk assessment are presented in these groups, namely age alone, clinical diagnosis before testing, the combination of both parameters, exercise-enhanced risk assessment, and the exercise criteria proposed by a Task Force for Ischemic Heart Disease (Bethesda Conference XVIII, 1986). We conclude that the exercise-enhanced risk assessment is the most effective of these strategies.
authors.affiliation: Department of Medicine, University of Washington, Seattle 98195.
authors.forename: R A
authors.initials: RA
authors.lastname: Bruce
authors.forename: L D
authors.initials: LD
authors.lastname: Fisher
mesh_terms: D000056:Accident Prevention; D000368:Aged; D003327:Coronary Disease / Q000517:prevention & control*; D003645:Death, Sudden; D005080:Exercise Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control; D009784:Occupational Diseases / Q000517:prevention & control*; D012307:Risk Factors; D012449:Safety