Access to non-physician led Exercise Stress Echocardiography reduces wait times and improves consumer engagement.

The performing of non-physician led exercise stress testing with and without echocardiography has shown similar diagnostic utility and safety as physician led models. While diagnostic accuracy and relative safety have been the focus of previous research, the current study aims to demonstrate efficiencies not previously reported such as reduction in wait times for testing and improved service attendance. A non-physician led exercise stress echocardiography (ESE) service was implemented on 01/01/2018, prior to this all tests were performed under a physician led model.

Energy wavelet signal processed ECG and standard 12 lead ECG: Diagnosis of early diastolic dysfunction.

Background: Left ventricular (LV) diastolic dysfunction (LVDD) is the result of impaired LV relaxation and identifies those at risk of developing heart failure. Echocardiography has been used as the gold standard to identify early LVDD. The signal processed electrocardiogram (hsECG) has demonstrated effectiveness to detect early LVDD.

Rate pressure product, age predicted maximum heart rate or heart rate reserve. Which one better predicts cardiovascular events following exercise stress echocardiography?

Background: Age-predicted maximum heart rate (APMHR) has been demonstrated to be a poor predictor of future cardiovascular (CV) events and is yet to be validated as a termination point during exercise testing. In contrast, maximum rate pressure product (MRPP) is recognized as a strong predictor of CV outcome with superior CV event prediction over APMHR. Heart rate reserve (HRR) has been shown to be a powerful predictor of CV mortality during exercise testing, however thus far, this is not confirmed for non-fatal CV events.

Safety and Efficacy of Scientist Led Exercise Stress Testing for Arrhythmia Provocation and Chronotropic Competence.

For many years, non physician led exercise stress testing performed for the investigation of coronary artery disease has been endorsed by many cardiovascular (CV) societies and associations around the world. The safety guidelines don't currently include the performing of these tests for arrhythmia provocation or chronotropic assessment. Therefore, the aim of this study was to assess the safety and efficacy of non physician led EST performed for suspected arrhythmias, chronotropic competence, long QT, and accessory pathway conduction (APC) assessment.

Scientist-led Exercise Testing Is Safe With Diagnostic Interpretation Equivalent to a Cardiologist.

Background: The implementation of nonphysician-led exercise stress testing (EST) has increased over the last 30 years, with endorsement by many cardiovascular societies around the world. The comparable safety of nonphysician-led EST to physician-led studies has been demonstrated, with some studies also showing agreement in diagnostic preliminary interpretations.

Objective: The study aim was to firstly confirm the safety of nonphysician-led EST in a large cohort and secondly compare the interobserver agreement and diagnostic accuracy of cardiac scientist and junior medical officer (JMO)-led EST reports to cardiology consultant overreads.

Comparison of heart rate reserve, age predicted maximum heart rate and rate pressure product as predictors of future cardiovascular events following a negative dobutamine stress echocardiogram.

Dobutamine stress echocardiography (DSE) is a commonly used diagnostic stress test for the assessment of various cardiac pathologies on patients unable to perform exercise. Unlike exercise, there is no reliable subjective termination end-point such as fatigue to rely on. Consequently, DSE's are often concluded at a predetermined age predicted maximal heart rate (APMHR) such as 85%.

Comparison of Heart Rate Blood Pressure Product Versus Age-Predicted Maximum Heart Rate as Predictors of Cardiovascular Events During Exercise Stress Echocardiography.

Exercise stress echocardiograms (ESEs) are a functional cardiovascular (CV) test typically used for the investigation of coronary artery disease. ESEs are often terminated at a predetermined age-predicted maximum heart rate (APMHR) to facilitate timely acquisition of ultrasound images at peak exercise. Although an APMHR of 85% is often used, this has not been validated as a suitable termination end point.

Handrail support produces a higher rate pressure product in apparently healthy non-treadmill users during maximal exercise testing.

Objective: Exercise treadmill testing (ETT) is a well-established procedure for the diagnosis, prognosis and functional assessment of patients with suspected cardiovascular disease. The use of handrail support during ETT is often discouraged as this has been demonstrated to overestimate functional capacity. It is unknown if this increase in functional capacity translates to an increase in cardiac workload.

Is downstream cardiac testing required in patients with reduced functional capacity and otherwise negative exercise stress test? A single center observational study.

Background: Exercise stress testing (EST) in patients with poor functional capacity measured by time on treadmill is typically deemed inconclusive and usually leads to further downstream testing. The aim of this study was firstly to evaluate the maximum rate pressure product (MRPP) during initial EST to assessthe need for follow-up testing; and secondly to investigate if MRPP is better than age predicted maximum heart rate (APMHR) for diagnostic outcome based on follow up cardiovascular (CV) events in patients with inconclusive EST due to poor functional capacity.

Methods: From a total of 2761 tests performed, 236 tests were considered inconclusive due to poor functional capacity which were available for analysis.

Two Models to Conduct Nonphysician-led Exercise Stress Testing in Low to Intermediate Risk Patients.

Background: Exercise stress testing (EST) is a noninvasive procedure that aids the diagnosis and prognosis of a range of cardiac pathologies. Reduced access is recognized as a limiting factor in enabling early access to treatment or safe and appropriate discharge. Increased accessibility can be achieved by utilizing nonphysician health practitioners to supervise tests.

Key findings on ECGs - level of agreement between GPs and cardiologists.

Background: Previous research has demonstrated accuracies of 70% for the detection of electrocardiogram (ECG) abnormalities by general practitioners. This study aimed to retrospectively assess the level of agreement between GPs and cardiologists of key findings on ECGs.

Methods: A retrospective study of all patient referrals from GPs sent to a cardiology clinic at a medium sized public hospital over a 3 year period.

Exercise-induced Brugada sign.

The Brugada syndrome has been described as a genetic disorder involving aborted sudden cardiac death in patients with apparently structurally normal hearts. Exercise has been shown to unmask the electrocardiographic (ECG) findings in this disease; however, this is yet to be validated as a useful testing method. This is a case of exercise-induced typical Brugada syndrome ECG changes with no occurrence of arrhythmias during exercise and no ECG evidence prior to testing.

Midazolam syrup as a premedication to reduce the discomfort associated with pediatric intravenous catheter insertion.

This randomized, double-blind, placebo-controlled study evaluated midazolam syrup for reducing discomfort from intravenous placement in children 9 months to 6 years. Parents and observers rated the child's discomfort by using visual analogue scales. Median parents' pain scores were significantly lower in the midazolam than the placebo group (P =.