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Stress Testing Algorithm (Outpatient)

Stress Testing Algorithm (Outpatient) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Cardiovascular, Related


Follow-up with
PCP
Stress Test Ordered
by ED
Expedited
Cardiology Evaluation
(i.e., TAC consult,
Cardiology Clinic, Stress
reader)
Admit to CVM vs.
OP cath
Contraindications
to stress testing?
Patient able
to exercise?
No
Known CAD?
Yes
Perform Pharm Stress MPI (AHA Class I, LOE B)
OR Pharm Stress with Echo (AHA Class I, LOE B)
No
Resting ECG
interpretable?
No
Perform MPI with Exercise
(AHA Class IIa, LOE B)
OR Exercise Echo (AHA Class I, LOE B)
Yes
Perform MPI with
Exercise
(AHA Class I, LOE B)
OR
Exercise Echo
(AHA Class I, LOE B)
No
Chest Pain APP places order
Result:
High risk
Result:
Low risk

References
1. Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes: A Report of the American College of Cardiology/
American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130(25):e344-426.
2. Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of
Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses
Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2012;126(25):e354-471.
UW Health Stress Testing Algorithm
For Patients Discharged from the ED for Testing
UW Health Management of Non-ST
Elevation Acute Coronary Syndromes
– Adult – Inpatient/Ambulatory
Clinical Practice Guideline
Expedited Follow-up with
the PCP or Cardiology
Clinic
Yes
Use CAD Consortium 1 Risk Calculator
Low Pretest Probability (< 25%):
Perform Standard Exercise ECG (AHA Class IIa, LOE C)
Intermediate/High Likelihood IHD (> 25%):
Perform MPI with Exercise (AHA Class IIa, LOE B)
OR Exercise Stress with Echo (AHA Class IIa, LOE B)
Yes
Order reviewed by
Chest Pain APP
EF < 40% or
unknown?
No
Perform MPI with Exercise
(AHA Class I, LOE B)
Yes
Result:
Moderate risk
Review Test Result
Guideline-directed
Medical Therapy for
Stable Ischemic Heart
Disease
Follow-up with PCP
(with Cardiology
referral as needed)
Copyright © 2017 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2017CCKM@uwhealth.org