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A Survey of Procedures, Safety, and Litigation Experience in Approximately 170,000 Tests

Paul Rochmis, MD; Henry Blackburn, MD

JAMA. 1971;217(8):1061-1066.

Abstract
This report surveys the techniques, safety and litigation experience of 170,000 exercise stress tests performed in 73 medical centers. Procedures and results varied but certain patterns emerged: (1) A medical history was required before testing in 89% of centers, a physical examination in 97%, and a resting electrocardiogram in 57%. (2) Active cardiac disease precluded testing. (3) Informed consent was sought in 75% and was required in written form in 30%. (4) Specific test-interruption criteria involved symptoms, signs, and ECG findings. (5) Progressive workloads were employed by 73%. (6) Full resuscitation facilities were available. (7) The mortality was about 1 per 10,000 tests (16 per 170,000). (8) Combined mortalitymorbidity was about 4 per 10,000 tests. (9) Mortality was not clearly related to type of test. (10) Successful litigation, with an out-of-court settlement was reported in one instance.

Author Affiliations
From the Heart Disease and Stroke Control Program, Public Health Service, Arlington, Va (Dr. Rochmis); and the Laboratory of Physiological Hygiene, University of Minnesota, Minneapolis (Dr. Blackburn). Dr. Rochmis is now in Fairfax, Va.

Footnotes
The detailed questionnaire used was entitled, "Exercise Testing:

Reprint requests to Laboratory of Physiological Hygiene, University of Minnesota, Minneapolis 55455 (Dr. Blackburn).

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