Receipt of cardiac screening does not influence 1-year post-cerebrovascular event mortality

Jason J. Sico, Fitsum Baye, Laura J. Myers, John Concato, Jared Ferguson, Eric M. Cheng, Farid Jadbabaie, Zhangsheng Yu, Gregory Arling, Alan J. Zillich, Mathew J. Reeves, Linda Williams, Dawn Bravata

Research output: Contribution to journalArticle

Abstract

Background American Heart Association/American Stroke Association expert consensus guidelines recommend consideration of cardiac stress testing to screen for occult coronary heart disease (CHD) among patients with ischemic stroke/TIA who have a high-risk Framingham Cardiac Risk Score (FCRS). Whether this guideline is being implemented in routine clinical practice, and the association of its implementation with mortality, is less clear. Methods Study participants were Veterans with stroke/TIA (n = 11,306) during fiscal year 2011 who presented to a VA Emergency Department or who were admitted. Patients were excluded (n = 6,915) based on prior CHD/angina/chest pain history, receipt of cardiac stress testing within 18 months prior to cerebrovascular event, death within 90 days of discharge, discharge to hospice, transfer to a non-VA acute care facility, or missing/unknown race. FCRS ≥20% was classified as high risk for CHD. ICD-9 and Common Procedural Terminology codes were used to identify receipt of any cardiac stress testing. Results Among 4,391 eligible patients, 62.8% (n = 2,759) had FCRS ≥20%. Cardiac stress testing was performed infrequently and in similar proportion among high-risk (4.5% [123/2,759]) vs low/intermediate-risk (4.4% [72/1,632]) patients (adjusted odds ratio [aOR] 0.77, 95% confidence interval [CI] 0.54-1.10). Receipt of stress testing was not associated with reduced 1-year mortality (aOR 0.59, CI 0.26-1.30). Conclusions In this observational cohort study of patients with cerebrovascular disease, cardiac screening was relatively uncommon and was not associated with 1-year mortality. Additional work is needed to understand the utility of CHD screening among high-risk patients with cerebrovascular disease. ©

Original languageEnglish (US)
Pages (from-to)192-200
Number of pages9
JournalNeurology: Clinical Practice
Volume8
Issue number3
DOIs
StatePublished - Jun 1 2018

Fingerprint

Mortality
Coronary Disease
Cerebrovascular Disorders
Stroke
Odds Ratio
Guidelines
Confidence Intervals
Hospices
International Classification of Diseases
Veterans
Chest Pain
Terminology
Observational Studies
Hospital Emergency Service
Cohort Studies

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Receipt of cardiac screening does not influence 1-year post-cerebrovascular event mortality. / Sico, Jason J.; Baye, Fitsum; Myers, Laura J.; Concato, John; Ferguson, Jared; Cheng, Eric M.; Jadbabaie, Farid; Yu, Zhangsheng; Arling, Gregory; Zillich, Alan J.; Reeves, Mathew J.; Williams, Linda; Bravata, Dawn.

In: Neurology: Clinical Practice, Vol. 8, No. 3, 01.06.2018, p. 192-200.

Research output: Contribution to journalArticle

Sico, JJ, Baye, F, Myers, LJ, Concato, J, Ferguson, J, Cheng, EM, Jadbabaie, F, Yu, Z, Arling, G, Zillich, AJ, Reeves, MJ, Williams, L & Bravata, D 2018, 'Receipt of cardiac screening does not influence 1-year post-cerebrovascular event mortality', Neurology: Clinical Practice, vol. 8, no. 3, pp. 192-200. https://doi.org/10.1212/CPJ.0000000000000465
Sico, Jason J. ; Baye, Fitsum ; Myers, Laura J. ; Concato, John ; Ferguson, Jared ; Cheng, Eric M. ; Jadbabaie, Farid ; Yu, Zhangsheng ; Arling, Gregory ; Zillich, Alan J. ; Reeves, Mathew J. ; Williams, Linda ; Bravata, Dawn. / Receipt of cardiac screening does not influence 1-year post-cerebrovascular event mortality. In: Neurology: Clinical Practice. 2018 ; Vol. 8, No. 3. pp. 192-200.
@article{401f034f5be348a98a0e181b16a0f5f0,
title = "Receipt of cardiac screening does not influence 1-year post-cerebrovascular event mortality",
abstract = "Background American Heart Association/American Stroke Association expert consensus guidelines recommend consideration of cardiac stress testing to screen for occult coronary heart disease (CHD) among patients with ischemic stroke/TIA who have a high-risk Framingham Cardiac Risk Score (FCRS). Whether this guideline is being implemented in routine clinical practice, and the association of its implementation with mortality, is less clear. Methods Study participants were Veterans with stroke/TIA (n = 11,306) during fiscal year 2011 who presented to a VA Emergency Department or who were admitted. Patients were excluded (n = 6,915) based on prior CHD/angina/chest pain history, receipt of cardiac stress testing within 18 months prior to cerebrovascular event, death within 90 days of discharge, discharge to hospice, transfer to a non-VA acute care facility, or missing/unknown race. FCRS ≥20{\%} was classified as high risk for CHD. ICD-9 and Common Procedural Terminology codes were used to identify receipt of any cardiac stress testing. Results Among 4,391 eligible patients, 62.8{\%} (n = 2,759) had FCRS ≥20{\%}. Cardiac stress testing was performed infrequently and in similar proportion among high-risk (4.5{\%} [123/2,759]) vs low/intermediate-risk (4.4{\%} [72/1,632]) patients (adjusted odds ratio [aOR] 0.77, 95{\%} confidence interval [CI] 0.54-1.10). Receipt of stress testing was not associated with reduced 1-year mortality (aOR 0.59, CI 0.26-1.30). Conclusions In this observational cohort study of patients with cerebrovascular disease, cardiac screening was relatively uncommon and was not associated with 1-year mortality. Additional work is needed to understand the utility of CHD screening among high-risk patients with cerebrovascular disease. {\circledC}",
author = "Sico, {Jason J.} and Fitsum Baye and Myers, {Laura J.} and John Concato and Jared Ferguson and Cheng, {Eric M.} and Farid Jadbabaie and Zhangsheng Yu and Gregory Arling and Zillich, {Alan J.} and Reeves, {Mathew J.} and Linda Williams and Dawn Bravata",
year = "2018",
month = "6",
day = "1",
doi = "10.1212/CPJ.0000000000000465",
language = "English (US)",
volume = "8",
pages = "192--200",
journal = "Neurology: Clinical Practice",
issn = "2163-0402",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Receipt of cardiac screening does not influence 1-year post-cerebrovascular event mortality

AU - Sico, Jason J.

AU - Baye, Fitsum

AU - Myers, Laura J.

AU - Concato, John

AU - Ferguson, Jared

AU - Cheng, Eric M.

AU - Jadbabaie, Farid

AU - Yu, Zhangsheng

AU - Arling, Gregory

AU - Zillich, Alan J.

AU - Reeves, Mathew J.

AU - Williams, Linda

AU - Bravata, Dawn

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Background American Heart Association/American Stroke Association expert consensus guidelines recommend consideration of cardiac stress testing to screen for occult coronary heart disease (CHD) among patients with ischemic stroke/TIA who have a high-risk Framingham Cardiac Risk Score (FCRS). Whether this guideline is being implemented in routine clinical practice, and the association of its implementation with mortality, is less clear. Methods Study participants were Veterans with stroke/TIA (n = 11,306) during fiscal year 2011 who presented to a VA Emergency Department or who were admitted. Patients were excluded (n = 6,915) based on prior CHD/angina/chest pain history, receipt of cardiac stress testing within 18 months prior to cerebrovascular event, death within 90 days of discharge, discharge to hospice, transfer to a non-VA acute care facility, or missing/unknown race. FCRS ≥20% was classified as high risk for CHD. ICD-9 and Common Procedural Terminology codes were used to identify receipt of any cardiac stress testing. Results Among 4,391 eligible patients, 62.8% (n = 2,759) had FCRS ≥20%. Cardiac stress testing was performed infrequently and in similar proportion among high-risk (4.5% [123/2,759]) vs low/intermediate-risk (4.4% [72/1,632]) patients (adjusted odds ratio [aOR] 0.77, 95% confidence interval [CI] 0.54-1.10). Receipt of stress testing was not associated with reduced 1-year mortality (aOR 0.59, CI 0.26-1.30). Conclusions In this observational cohort study of patients with cerebrovascular disease, cardiac screening was relatively uncommon and was not associated with 1-year mortality. Additional work is needed to understand the utility of CHD screening among high-risk patients with cerebrovascular disease. ©

AB - Background American Heart Association/American Stroke Association expert consensus guidelines recommend consideration of cardiac stress testing to screen for occult coronary heart disease (CHD) among patients with ischemic stroke/TIA who have a high-risk Framingham Cardiac Risk Score (FCRS). Whether this guideline is being implemented in routine clinical practice, and the association of its implementation with mortality, is less clear. Methods Study participants were Veterans with stroke/TIA (n = 11,306) during fiscal year 2011 who presented to a VA Emergency Department or who were admitted. Patients were excluded (n = 6,915) based on prior CHD/angina/chest pain history, receipt of cardiac stress testing within 18 months prior to cerebrovascular event, death within 90 days of discharge, discharge to hospice, transfer to a non-VA acute care facility, or missing/unknown race. FCRS ≥20% was classified as high risk for CHD. ICD-9 and Common Procedural Terminology codes were used to identify receipt of any cardiac stress testing. Results Among 4,391 eligible patients, 62.8% (n = 2,759) had FCRS ≥20%. Cardiac stress testing was performed infrequently and in similar proportion among high-risk (4.5% [123/2,759]) vs low/intermediate-risk (4.4% [72/1,632]) patients (adjusted odds ratio [aOR] 0.77, 95% confidence interval [CI] 0.54-1.10). Receipt of stress testing was not associated with reduced 1-year mortality (aOR 0.59, CI 0.26-1.30). Conclusions In this observational cohort study of patients with cerebrovascular disease, cardiac screening was relatively uncommon and was not associated with 1-year mortality. Additional work is needed to understand the utility of CHD screening among high-risk patients with cerebrovascular disease. ©

UR - http://www.scopus.com/inward/record.url?scp=85054005004&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85054005004&partnerID=8YFLogxK

U2 - 10.1212/CPJ.0000000000000465

DO - 10.1212/CPJ.0000000000000465

M3 - Article

VL - 8

SP - 192

EP - 200

JO - Neurology: Clinical Practice

JF - Neurology: Clinical Practice

SN - 2163-0402

IS - 3

ER -