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Cardiac Screening Does Not Improve One-year Mortality Among Patients with Cerebrovascular Disease
Sico JJ, Baye F, Myers L, Concato J, Williams LS, Bravata DM. Cardiac Screening Does Not Improve One-year Mortality Among Patients with Cerebrovascular Disease. [Abstract]. Stroke; A Journal of Cerebral Circulation. 2016 Feb 1; 47(Suppl 1):ATP165.
Introduction: Guidelines recommend the use 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). It is unclear whether implementation of this guideline confers a mortality benefit among patients with cerebrovascular disease.
Hypothesis: We assessed the hypothesis that cardiac stress testing would be associated with lower odds of one-year all-cause mortality.
Methods: Administrative data from a sample of 11,306 Veterans admitted to 134 Veterans Health Administration (VHA) facilities with a stroke or TIA in fiscal year 2011 were analyzed. Patients were excluded (n = 6915) on the basis of: prior CHD history, receipt of cardiac stress testing within 18-months prior to cerebrovascular event, death within 90 days of discharge, being discharged to hospice, transferred to a non-VHA acute care facility, or missing/unknown race. A FCRS was calculated for each patient; a score of 20% was classified as 'high risk' of having CHD. Administrative data were used to identify whether cardiac stress testing was performed within 90-days after the cerebrovascular event. Logistic regression was used to assess whether cardiac stress testing was associated with one-year all-cause mortality.
Results: Of the 4391 eligible patients, 62.8% (2759) had FCRS 20%, with 4.5% (n = 123) of these patients receiving cardiac stress testing within 90 days of discharge. After adjusting for sociodemographic characteristics and medical comorbidities, FCRS 20% was associated with one-year mortality (aOR = 2.18; CI95:1.59, 3.00), however, receipt of stress testing was not (aOR = 0.59; CI95:0.26, 1.30).
Conclusion: Cardiac screening did not confer a one-year all-cause mortality benefit among patients with cerebrovascular disease. Additional work is needed to assess outcomes among patients with cerebrovascular disease who are at 'high risk' for CHD.