A 1989 survey (unpublished) of exercise testing practice in Scotland s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.