title: Trends in referral patterns, invasive management, and mortality in elderly patients referred for exercise stress testing.
abstract: BACKGROUND
  Scarce data are available on the temporal patterns in clinical characteristics and outcomes of elderly patients referred for exercise stress testing. We aimed to assess the trends in baseline characteristics, tests results, referrals for invasive management, and mortality in these patients.
  
  
  METHODS
  We evaluated 11,192 patients aged ≥65years who were referred for exercise stress testing between January 1998 and December 2013. Calendar years were grouped into four quadrennia (1998-2001, 2002-2005, 2006-2009, and 2010-2013), and trends in clinical characteristics of the patients, type and results of the tests, referrals for invasive management, and mortality across the different periods were assessed.
  
  
  RESULTS
  Despite a progressive decrease in the proportion of patients with non-interpretable baseline electrocardiograms or prior history of coronary artery disease, there was a gradual and marked increase in the use of cardiac imaging from 32.8% in 1998-2001 to 67.6% in 2010-2013 (p<0.001). In addition, despite a gradual decline in the probability of positive exercise stress testing both without imaging (from 18.9 to 13.6%, p<0.001) and with imaging assessment (from 40.2 to 29.7%, p<0.001), the cumulative rate of coronary revascularization at 1year increased (from 10.8 to 13.7%, p<0.001). One-year mortality also decreased progressively from 3% to 1.6% (p<0.001).
  
  
  CONCLUSIONS
  Among older adults referred for exercise stress testing, we observed a decline over time in the probability of inducible myocardial ischemia, an increase in the use of cardiac imaging and in the rate of coronary revascularization, and an improvement in the survival rate at 1year.
authors.affiliation: Unidad de Imagen y Función Cardíacas, Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain. Electronic address: alberto.bouzas.mosquera@sergas.es.
authors.forename: Alberto
authors.initials: A
authors.lastname: Bouzas-Mosquera
authors.affiliation: Unidad de Imagen y Función Cardíacas, Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Peteiro
authors.affiliation: Departamento de Tecnologías de la Información, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Broullón
authors.affiliation: Unidad de Hemodinámica, Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: Calviño-Santos
authors.affiliation: Servicio de Cirugía Cardiaca, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors.forename: Víctor X
authors.initials: VX
authors.lastname: Mosquera
authors.affiliation: Unidad de Imagen y Función Cardíacas, Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors.forename: Cayetana
authors.initials: C
authors.lastname: Barbeito-Caamaño
authors.affiliation: Unidad de Imagen y Función Cardíacas, Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Larrañaga-Moreira
authors.affiliation: Unidad de Imagen y Función Cardíacas, Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Maneiro-Melón
authors.affiliation: Unidad de Imagen y Función Cardíacas, Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors.forename: Nemesio
authors.initials: N
authors.lastname: Álvarez-García
authors.affiliation: Unidad de Hemodinámica, Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Vázquez-Rodríguez
mesh_terms: D000368:Aged; D057791:Cardiac Imaging Techniques / Q000379:methods / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality; D019468:Disease Management; D005080:Exercise Test / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends; D009204:Myocardial Revascularization / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D012017:Referral and Consultation / Q000706:statistics & numerical data / Q000639:trends; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D013997:Time Factors
keywords: Coronary angiography; Exercise stress testing; Mortality; Myocardial ischemia; Revascularization