Is nurse-supervised exercise stress testing safe practice?

OBJECTIVE: Nurses have been performing exercise stress tests (EST) without medical supervision since 1978 in our hospital-based cardiac rehabilitation unit. This study was conducted to examine the incidence of cardiovascular complications and to describe the competency-based training program for the nurses performing the EST. DESIGN: Descriptive, retrospective audit of prospective data. SETTING: Single comprehensive cardiac rehabilitation center in a large tert iary referral hospital in western Sydney, Australia. SUBJECTS: Seventeen thousand, four hundred and sixty-seven patients were in cluded in this study over a 12-year period. METHOD: Data were collected on all ESTs performed by the cardiac rehabilita tion nurses from January 1986 to December 1997 in relation to serious cardi ovascular complications and other EST parameters. RESULTS: In this study, 17,467 ESTs were performed on 5054 patients who had 6273 separate presentations. The most common entry diagnosis was after an acute myocardial infarction (50%). The mean age was 58 +/- 10.5 years (rang e 15 to 87 years; 80% malej. The left ventricular ejection fraction (n = 28 22) was 49% +/- 14%. In a subgroup analysis of 14,454 patients, 14% had a p ositive EST (ST segment >1.9 mm depression). There were no deaths associate d with the EST, and there were 13 major complications in 12 patients. This figure included no cardiac arrests, 11 episodes of conscious sustained vent ricular tachycardia, 1 reinfarction, and 1 mitral valve rupture, representi ng a 0% mortality rate and a 0.075% major morbidity rate. CONCLUSION: This study shows that nurse-supervised EST of higher risk patie nts in the hospital-based cardiac rehabilitation setting has been a safe pr actice from a mortality and morbidity rate perspective. This finding may be accounted forby the high training standard and reaccreditation of the nurs es on the advanced practice of performing EST.