استفاده از تست ورزش در مراقبت های اولیه: اهمیت برای ارجاع تصمیم گیری و تعصب ممکن در فرایند تصمیم گیری؛ یک مطالعه مشاهده ای آینده نگر
Use of exercise tests in primary care: importance for referral decisions and possible bias in the decision process; a prospective observational study
نویسندگان |
این بخش تنها برای اعضا قابل مشاهده است ورودعضویت |
اطلاعات مجله |
Nilssonet al. BMC Family Practice2014,15:182 http://www.biomedcentral.com/1471-2296/15/182 |
سال انتشار |
2014 |
فرمت فایل |
PDF |
کد مقاله |
20962 |
پس از پرداخت آنلاین، فوراً لینک دانلود مقاله به شما نمایش داده می شود.
چکیده (انگلیسی):
Background:The utility of clinical exercise tests depends on their support of treatment decisions. We sought to
assess the utility of exercise tests for the selection of primary-care patients for referral to cardiologic care, and to
determine whether referral decisions were biased by gender or socioeconomic status.We also evaluated referral
rates and cardiovascular events in patients with positive exercise tests.
Methods:We designed a prospective observational study of 438 men and 427 women from 28 Swedish
primary-care clinics who were examined with exercise testing for suspected coronary disease. All participants
were followed-up with respect to cardiologist referrals and cardiovascular events (hospitalisation for unstable angina,
myocardial infarction, and cardiovascular death) within six months and revascularisation within 250 days. Variables
associated with referral were identified by multivariable logistic regression. Socioeconomic status was determined by
educational level and employment.
Results:Positive/inconclusive exercise tests and exertional chest pain predicted referral in men and women. Of 865
participants, patients with positive, inconclusive, or negative exercise tests were referred to cardiologists in 67.3%,
26.1%, and 3.5% of cases, respectively. Overall, there was no significant difference in referral rates related to gender or
socioeconomic level. Self-employed women were referred more frequently compared to other women (odds ratio (OR)
3.62, 95% confidence interval (CI) 1.19-10.99). Among non-manual employees, women were referred to cardiologic
examination less frequently than men (OR 0.40, 95% CI 0.16-1.00; p = 0.049; ORs adjusted for age, exertional chest pain,
and exercise test result). In patients with positive exercise tests, the referral rate decreased continuously with age (OR
0.48, 95% CI 0.23-0.97; adjusted for cardiovascular co-morbidity). Cardiovascular events occurred in 22.2% (4/18) of
non-referred patients with positive exercise tests; 56% (10/18) of these patients were not considered for cardiologic
care, with continuity problems in primary care as one possible contributing cause.
Conclusions:Exercise tests are important for selecting patients for referral to cardiologic care. Interactions related to
gender and socioeconomic status affected referral rates. In patients with positive exercise tests, referral rates decreased
with age. An increased awareness of possible bias regarding age, gender, and socioeconomic status, which may
influence medical decisions, is therefore necessary.
کلمات کلیدی مقاله (فارسی):
بیماری کرونر، تست ورزش، مراقبت های اولیه، ارجاع
کلمات کلیدی مقاله (انگلیسی):
Keywords:Coronary disease, Exercise test, Primary care, Referral
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