A SURVEY OF EXERCISE TESTING PRACTICE IN SCOTTISH HOSPITALS

A 1989 survey (unpublished) of exercise testing practice in Scotland s uggested that there were important differences in the practice of exer cise testing between hospitals. A postal questionnaire was sent to 30 teaching and district general hospitals in 1991 and followed up by tel ephone questioning of consultants. The numbers of exercise tests perfo rmed had increased to 22,012 in 1990, and a greater proportion were pe rformed in district general hospitals. General practitioners had very limited access to the service but hospital doctors of any grade had al most free access. Rationing of early post myocardial infarction testin g led to attempts to define ''high risk'' post infarction patients and this included inappropriate patients in many hospitals. A variety of different protocols was used. Eighteen out of 30 hospitals surveyed di scontinued beta blockers but only four hospitals took account of antia nginal, antihypertensive or other medication, and all but one exercise d patients while on digoxin. In the majority of hospitals decisions re garding drug therapy were taken by individual physicians. A variety of personnel reported tests, many without specialist training in cardiol ogy. Even among consultants there was no concensus on the degree of ST depression which was significant. Exercise tests performed in differe nt hospitals in Scotland are not comparable due to the wide variation in patient selection, test conditions, and interpretation of tests. Th is problem is likely to be exacerbated by the multiple personnel invol ved in all aspects of testing. It seem probable that there is a proble m throughout the United Kingdom, and that there is a need for guidelin es.