title: Safety of stress echocardiography supervised by registered nurses: results of a 2-year audit of 15,404 patients.
abstract: BACKGROUND
  Stress echocardiography has traditionally been performed under the supervision of physicians. In the last decade, at some institutions, specially trained registered nurses have taken on the task of directly supervising and conducting these stress tests with appropriate physician involvement and assistance.
  
  
  METHODS
  The safety of 15,404 stress echocardiograms that were performed under the direct supervision of registered nurses during a recent 2-year period was evaluated.
  
  
  RESULTS
  The stress modality was treadmill exercise in 8592 (56%), dobutamine in 6755 (44%), and transesophageal atrial pacing in 57 (0.04%) patients. The mean age was 65 +/- 13 years, and 54% were male. A total of 55 patients (0.36%) had complications related to stress echocardiography, including 26 patients (0.18%) who were subsequently transferred to hospital. Complications included atrial fibrillation (n = 28, 0.18%), other supraventricular tachycardias (n = 9, 0.06%), sustained ventricular tachycardia (n = 4, 0.03%), and ventricular fibrillation (n = 2, 0.01%). Eight patients (0.05%) were hospitalized for markedly positive tests or prolonged chest pain and 4 patients (0.03%) for symptomatic hypotension. No patient had cardiac rupture or died. Complications were more common with dobutamine stress echocardiography (DSE) (47/6755; 0.7%) compared with exercise echocardiography (8/8592; 0.09%) or transesophageal atrial pacing stress echocardiography (0/57) (P < .0001). Arrhythmias were more commonly associated with DSE (39/6755, 0.58%) than exercise echocardiography (4/8592, 0.05%). Potentially life-threatening ventricular arrhythmias occurred in 6 of 6755 patients who underwent DSE (0.09%) and in none of the patients who underwent exercise echocardiography. Patients who underwent DSE were, on average, older, and had more comorbidities compared with those who underwent exercise echocardiography.
  
  
  CONCLUSIONS
  Stress echocardiography, when supervised directly by specially trained registered nurses, can be performed safely; complications are uncommon (1/280 stress tests) and these complication rates are comparable with previously reported studies evaluating the safety of stress echocardiography supervised by physicians.
authors: Echocardiography Laboratory, Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
authors: Garvan C
authors: GC
authors: Kane
authors: Mary J
authors: MJ
authors: Hepinstall
authors: Glenda M
authors: GM
authors: Kidd
authors: Cathryn A
authors: CA
authors: Kuehl
authors: Amy T
authors: AT
authors: Murphy
authors: Janice M
authors: JM
authors: Nelson
authors: LeRae
authors: L
authors: Schneider
authors: Vicky L
authors: VL
authors: Stussy
authors: Jennifer A
authors: JA
authors: Warmsbecker
authors: Fletcher A
authors: FA
authors: Miller
authors: Patricia A
authors: PA
authors: Pellikka
authors: Robert B
authors: RB
authors: McCully
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000401:mortality*; D054869:Clinical Audit; D004452:Echocardiography / Q000401:mortality*; D005080:Exercise Test / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D009722:Nurse Practitioners / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012449:Safety / Q000706:statistics & numerical data