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Jonathan Myers

Publications and source records attributed to Jonathan Myers.

At least 37 records · Page 2Linked to original sources
PubMed2005

Prognostic characteristics of cardiopulmonary exercise testing in heart failure: comparing American and European models.

BACKGROUND: Cardiopulmonary exercise testing (CPET) in the heart failure population is a standard of care in both American and European clinics, although the mode of exercise typically differs. The purpose of the present study was to compare the prognostic characteristics of peak oxygen consumption (VO2) and the minute ventilation-carbon dioxide production (VE/VCO2) slope between two independent heart failure groups. DESIGN AND METHODS: One hundred and two subjects underwent maximal exercise CPET using bicycle ergometry at San Paolo Hospital in Milan, Italy (SPH) and 105 subjects underwent treadmill CPET at Virginia Commonwealth University in Richmond, Virginia (VCU). Subjects were tracked for cardiac-related mortality for a 1-year period after CPET. RESULTS: There were 13 cardiac-related deaths over the 1-year tracking period in both groups. Optimal prognostic threshold values for peak VO2 were 12.9 ml O2/kg per min (sensitivity 81%, specificity 69%) in the SPH group and 12.0 ml O2/kg per min (sensitivity 74%, specificity 69%) in the VCU group. An optimal prognostic threshold value for the VE/VCO2 slope was 34.4 in the SPH (sensitivity 61%, specificity 85%) and 34.5 in the VCU (sensitivity 64%, specificity 93%) groups. DISCUSSION: The prognostic characteristics of peak VO2 and the VE/VCO2 slope were similar between the two centers. These results suggest that the mode of exercise does not greatly impact the prognostic utility of CPET responses in heart failure. They further suggest that prognostic guidelines for the application of CPET in heart failure may be applied globally, irrespective of differences in testing modality.

Europe↗
PubMed2005

Level of disagreement between Proview phosphene tonometer and Goldmann applanation tonometer intraocular pressure readings.

PURPOSE: To evaluate the agreement of intraocular pressure (IOP) readings obtained with the Proview phosphene tonometer and those obtained by Goldmann applanation tonometry as well as the effect of regular use of the Proview on patients' anxiety about their glaucoma. METHODS: One hundred thirty-five consecutive patients with glaucoma, 35 designated as controls, were enrolled in a 10-month randomized prospective clinical trial. The study patients but not the controls used the Proview outside the office. At office visits IOP was measured by an ophthalmologist with the Goldmann applanation tonometer (GAT) as well as by examiners and patients using the Proview. Patients in the treatment group (n = 100) were asked to measure and record their IOP at home as well. Using ANOVA, we examined the relationship between demographic variables and the level of agreement between the Proview readings and those measured by GAT at the final office visit. All participants also were asked to complete a questionnaire regarding their anxiety about their IOP at the baseline and final office visits. The primary outcome measure was the level of agreement of the Proview measurements with those obtained by GAT. Secondary outcome measures included patients' anxiety about their glaucoma. RESULTS: The absolute mean difference between GAT and Proview readings at the final visit was 3.5 +/- 2.9 mm Hg (median, 2.8 mm Hg). The treatment group reported significantly less anxiety about their glaucoma after 4 to 6 weeks of using the Proview (P = .024). CONCLUSIONS: There was considerable discrepancy between Proview and GAT readings. However, regular use of the Proview tonometer significantly reduced patients' anxiety about their glaucoma.

Adolescent↗
PubMed2005

Clinical predictors of latanoprost treatment effect.

PURPOSE: To determine the relationship between latanoprost efficacy and clinical features of glaucoma. PATIENTS AND METHODS: Study design was retrospective, observational case series. The charts of all patients who underwent a one-eyed therapeutic trial of latanoprost during the course of their clinical care between 1997 and 2001 were reviewed. Intraocular pressures of both eyes prior to and one month after initiation of latanoprost were recorded. Latanoprost treatment effect was calculated by subtracting the change in intraocular pressure (IOP) in the fellow eye from the change in the treated eye. The effect of optic disc stage, age, race, sex, diagnosis, involved eye, type and number of other glaucoma medications, pattern of cupping (concentric, focal, or indeterminate), and pre-treatment IOP was correlated with the treatment effect. The stage of glaucoma was determined by determining the disc damage likelihood scale (DDLS) stage. RESULTS: One hundred eighty-six cases were included. Latanoprost treatment effect was 4.5 +/- 5.7 mm Hg, was moderately correlated with pre-treatment IOP (Pearson's r = 0.527, P < 0.01), and was weakly inversely correlated with advancing disc stage (Pearson's r = -0.194, P < 0.01) and age (Pearson's r = -0.175, P < 0.05). It was independent of the other variables studied (P > 0.05). CONCLUSION: Most clinical parameters examined in this study were not correlated with latanoprost treatment response. A moderate direct correlation was noted with pre-treatment IOP and a weak inverse correlation was noted with optic disc stage and age.

Adolescent↗
PubMed2005

Timolol/dorzolamide combination therapy as initial treatment for intraocular pressure over 30 mm Hg.

PURPOSE: To determine the intraocular pressure (IOP)-lowering effect of a fixed timolol/dorzolamide combination (Cosopt) for patients with IOP over 30 mm Hg. STUDY DESIGN: Prospective interventional case series. METHODS: Eighteen patients being seen on the Wills Eye Hospital Glaucoma Service with at least one eye with an IOP > 30 mm Hg were recruited. None had used any glaucoma medications for at least 1 month. IOP was confirmed by diurnal testing. Cosopt was administered at 9 am and 9 pm. Trough IOP measurements were made at 9 am and peak IOP measurements at 11 am at baseline, 1 month, and 2 months. Pretreatment and posttreatment IOPs were compared using a paired-samples independent t test. RESULTS: Mean pretreatment IOP was 37.5 +/- 1.0 mm Hg. Baseline posttreatment IOP was 18.4 +/- 0.5 mm Hg (P < 0.01). At 2 months, the mean trough IOP was 21.1 +/- 0.9 mm Hg and the peak, 17.6 +/- 0.6 mm Hg (each, P < 0.01, as compared with pretreatment baseline IOP). One patient did not respond to Cosopt; two had a clinically insufficient response and did not complete the study. Data from these patients were included in the analysis. CONCLUSIONS: Over 80% of the eyes responded to Cosopt, with an average trough IOP reduction of 40% at 2 months.

Adult↗
PubMed2005

Exercise-induced ventricular arrhythmias and cardiovascular death.

BACKGROUND: Exercise-induced ventricular arrhythmias (EIVA) are frequently observed during exercise testing. However, the clinical guidelines do not specify their significance and so we examined this issue in our population. METHODS: A retrospective analysis of prospectively collected data was performed on 5754 consecutive male veterans referred for exercise testing at two university-affiliated Veterans Affairs Medical Centers. Exercise test responses were recorded and cardiovascular mortality was assessed after a mean follow-up of 6 +/- 4 years. EIVA were defined as frequent premature ventricular complexes (PVCs) constituting more than 10% of all ventricular depolarizations during any 30-second ECG recording, or a run of three or more consecutive PVCs during the exercise test or recovery. RESULTS: EIVA occurred in 426 patients (7.4%). There were 550 (10.6%) cardiovascular deaths during follow-up. Seventy two (17%) patients with EIVA died of cardiovascular causes, whereas 478 (9.0%) of patients without EIVA died of cardiovascular causes (P < 0.001). Patients with EIVA had a higher prevalence of cardiovascular disease, resting PVCs, resting ST depression, and ischemia during exercise than patients without EIVA. In a Cox hazards model adjusted for age, cardiovascular disease, exercise-induced ischemia, ECG abnormalities, exercise capacity and risk factors, EIVA was significantly associated with time to cardiovascular death. The combination of both resting PVCs and EIVA was associated with the highest hazard ratio. CONCLUSIONS: EIVA are independent predictors of cardiovascular mortality after adjusting for other clinical and exercise test variables; combination with resting PVCs carries the highest risk.

Analysis of Variance↗
PubMed2005

T-wave abnormalities are a better predictor of cardiovascular mortality than ST depression on the resting electrocardiogram.

BACKGROUND: ST depression and T-wave amplitude abnormalities are known to be independent predictors of cardiovascular (CV) death, but a direct comparison between them has not been described. METHODS: Analyses were performed on the first electrocardiogram (ECG) digitally recorded on 46,950 consecutive patients at the Palo Alto Veterans Affairs Medical Center since 1987. Females and patients with electrocardiograms exhibiting bundle branch block, left ventricular hypertrophy, electronic pacing, diagnostic Q waves, or Wolff-Parkinson-White syndrome were excluded, leaving 31,074 male patients for analysis (mean age 55 +/- 14). There were 1878 (6.0%) cardiovascular deaths (mean follow-up of 6 +/- 4 years). Electrocardiograms were classified using Minnesota code according to the degree of ST depression and T-wave abnormality, and the nine possible combinations of ST segment and T-wave abnormalities were recoded for analysis. RESULTS: The combination of major abnormalities in ST segments and T-waves carried the greatest hazard [3.2 (CI 2.7-3.8)]. Minor ST depression combined with more severe T-wave abnormalities carried a hazard of 3.1 (CI 2.5-3.7), whereas minor T-wave abnormalities combined with more severe ST depression carried a hazard of only 1.9 (CI 1.6-2.3). CONCLUSION: While both ST segment depression and abnormal T-wave amplitude are clinically important, T-wave abnormalities appear to be greater predictors of cardiovascular mortality.

Aged↗
PubMed2005

Impact of the exercise mode on exercise capacity: bicycle testing revisited.

STUDY OBJECTIVE: To test the performance of a tool designed to estimate functional capacity in order to select a bicycle ramp protocol yielding a test duration from 8 to 12 min in healthy individuals, and to assess differences in exercise responses between bicycle and treadmill tests. PARTICIPANTS AND MEASURES: Forty-one healthy and physically active volunteers (10 women; median age, 37 years; interquartile range [IQR], 29.5 to 41 years) performed an individualized ramp exercise protocol on a bicycle ergometer and a treadmill in random order. Prior to testing, the Veterans Specific Activity Questionnaire (VSAQ) combined with a modified variant of the VSAQ nomogram (metabolic equivalents [METs] derived from VSAQ and age with the modified nomogram, resulting in METs nomogram) was used to estimate exercise capacity and to select the treadmill protocol. The corresponding bicycle work capacity nomogram (in watts) was derived by the following equation: (METs nomogram - 1) x body weight/3.486. RESULTS: Using treadmill tests, all 41 participants (100%) achieved maximal exercise from 8 to 12 min, as compared to 33 participants (80%) for the bicycle tests (p = 0.003). Peak oxygen uptake (V(O2)) [bicycle: median, 49.7 mL/kg/min (IQR, 45.4 to 56.6 mL/kg/min); vs treadmill: median, 53.1 mL/kg/min (IQR, 47.3 to 57.7 mL/kg/min; p < 0.0001)] was lower using the bicycle compared to the treadmill. However, the difference in peak V(O2) values between the two exercise modes was lower (2.6 mL/kg/min; IQR, 1.1 to 4.3 mL/kg/min), corresponding to 4.6% (IQR, 2.4 to 8.5%) of the lower of both values than reported in previous studies, and seven participants (17%) even achieved a higher peak V(O2) using the bicycle. CONCLUSIONS: A modified version of the VSAQ can be effectively used to select appropriate ramp rates for exercise testing using a bicycle ergometer in healthy individuals. Differences in maximal responses are less than those previously reported, suggesting that the bicycle ergometer is an appropriate alternative to the treadmill test in healthy volunteers.

Activities of Daily Living↗
PubMed2005

Influence of heart failure etiology on the prognostic value of peak oxygen consumption and minute ventilation/carbon dioxide production slope.

BACKGROUND: Peak oxygen consumption (V(O2)) and minute ventilation (V(E))/carbon dioxide production (V(CO2)) slope have been widely demonstrated to have strong prognostic value in patients with heart failure (HF). In the present study, we investigated the effect of HF etiology on the prognostic applications of peak V(O2) and Ve/V(CO2) slope. METHODS: Two hundred sixty-eight subjects underwent symptom-limited cardiopulmonary exercise testing (CPX). The population was divided into ischemic (115 men and 22 women) and nonischemic (108 men and 23 women) subgroups. The occurrence of cardiac-related events over the year following CPX was compared between groups using receiver operating characteristic curve (ROC) analysis RESULTS: Mean age +/- SD was significantly higher (61.0 +/- 10.0 years vs 50.3 +/- 16.2 years) while mean peak V(O2) was significantly lower (15.0 +/- 5.2 mL/kg/min vs 17.5 +/- 6.7 mL/kg/min) in the ischemic HF group (p < 0.05). ROC curve analysis demonstrated that both peak V(O2) and V(E)/V(CO2) slope were significant predictors of cardiac events in both the ischemic group (peak V(O2), 0.74; V(E)/V(CO2) slope, 0.76; p < 0.001) and the nonischemic group (peak V(O2), 0.75; V(E)/V(CO2) slope, 0.86; p < 0.001). Optimal prognostic threshold values for peak V(O2) were 14.1 mL/kg/min and 14.6 mL/kg/min in the ischemic and nonischemic groups, respectively. Optimal prognostic threshold values for the V(E)/V(CO2) slope were 34.2 and 34.5 in the ischemic and nonischemic groups, respectively. CONCLUSIONS: Baseline and exercise characteristics were different between ischemic and nonischemic patients with HF. However, the prognostic power of the major CPX variables was strikingly similar. Different prognostic classification schemes based on HF etiology may therefore not be necessary when analyzing CPX responses in clinical practice.

Carbon Dioxide↗
PubMed2004

Fitness versus physical activity patterns in predicting mortality in men.

PURPOSE: To compare the contributions of fitness level and physical activity patterns to all-cause mortality. METHODS: Of 6213 men referred for exercise testing between 1987 and 2000, 842 underwent an assessment of adulthood activity patterns. The predictive power of exercise capacity and activity patterns, along with clinical and exercise test data, were assessed for all-cause mortality during a mean (+/-SD) follow-up of 5.5 +/- 2 years. RESULTS: Expressing the data by age-adjusted quartiles, exercise capacity was a stronger predictor of mortality than was activity pattern (hazard ratio [HR] = 0.56; 95% confidence interval [CI]: 0.38 to 0.83; P < 0.001). In a multivariate analysis that considered clinical characteristics, risk factors, exercise test data, and activity patterns, exercise capacity (HR per quartile = 0.62; CI: 0.47 to 0.82; P < 0.001) and energy expenditure from adulthood recreational activity (HR per quartile = 0.72; 95% CI: 0.58 to 0.89; P = 0.002) were the only significant predictors of mortality; these two variables were stronger predictors than established risk factors such as smoking, hypertension, obesity, and diabetes. Age-adjusted mortality decreased per quartile increase in exercise capacity (HR for very low capacity = 1.0; HR for low = 0.59; HR for moderate = 0.46; HR for high = 0.28; P < 0.001) and physical activity (HR for very low activity = 1.0; HR for low = 0.63; HR for moderate = 0.42; HR for high = 0.38; P < 0.001). A 1000-kcal/wk increase in activity was approximately similar to a 1 metabolic equivalent increase in fitness; both conferred a mortality benefit of 20%. CONCLUSION: Exercise capacity determined from exercise testing and energy expenditure from weekly activity outperform other clinical and exercise test variables in predicting all-cause mortality.

Aged↗
PubMed2004

Treadmill scores in elderly men.

OBJECTIVES: This study seeks to further characterize the role of exercise testing in the elderly for prognosis and diagnosis of coronary artery disease. BACKGROUND: Recent exercise testing guidelines have recognized that statements regarding the elderly do not have an adequate evidence-based quality because the studies they are based on have limitations in sample size and design. The Duke Treadmill Score has been recommended for risk stratification, but recent evidence has suggested that it does not function in the elderly. METHODS: The study population consisted of male veterans (1872 patients >or=65 years; 3798 patients <65 years) who underwent routine clinical exercise testing with a mean follow-up of six years. A subset who underwent coronary angiography as clinically indicated (elderly, n = 405; younger, n= 809) were included. The primary outcome for all subjects was cardiovascular mortality with coronary angiographic findings as the outcome in those selected for angiography. RESULTS: In survival analysis, exercise-induced ST depression was prognostic in both age groups only when cardiovascular death was considered as the end point. Peak metabolic equivalents were the most significant predictor for both age groups only when all-cause death was considered as the end point. New age-specific prognostic scores were developed and found to be predictive for cardiovascular mortality in the elderly. Moreover, in the angiographic subset of the elderly, a specific diagnostic score provided significantly better discrimination than exercise ST measurements alone. For any new score, there is a need for validation in another elderly population. CONCLUSIONS: The mortality end point affected the choice of prognostic variables. This study demonstrates that exercise test scores can be helpful for the diagnosis and prognosis of coronary disease in the elderly.

Aged↗
PubMed2004

Predictors of exercise capacity and the impact of angiographic coronary artery disease in heart transplant recipients.

BACKGROUND: Maximal exercise capacity is limited in patients after heart transplantation. The extent to which transplant coronary artery disease contributes to exercise intolerance in these patients has not been well defined. METHODS: This prospective study examined exercise capacity among 174 heart transplant recipients who underwent 358 exercise tests 0.3 to 13 years after surgery. Data were collected as part of routine posttransplantation treatment that each year consist of clinical and hemodynamic measurements (including ejection fraction, cardiac index, pulmonary capillary wedge pressure, and the presence of coronary artery disease) and cardiopulmonary exercise test (including measures of peak VO2). The mean follow-up was 3.5 +/- 0.2 years after transplantation. Serial exercise test data were available in 102 patients RESULTS: Peak VO2 was 19.4 +/- 0.4 mL/kg per minute, representing 70% +/- 1.3% of the age-predicted value. Exercise capacity increased significantly after transplantation and then remained stable throughout long-term follow-up. Only age, maximal systolic blood pressure, pulmonary vascular resistance, and body mass index were independent determinants of exercise capacity (R2 = 0.51), whereas specific transplant factors such as denervation, hemodynamic variables, donor characteristics, immunosuppressive drugs, biochemical parameters, and transplant coronary artery disease (TxCAD) did not contribute to the explanation of reduced exercise capacity. Although TxCAD was not related to exercise capacity in the multivariate analysis, exercise capacity declined by 17.1% (P <.05) among those in whom CAD developed during follow-up. CONCLUSIONS: Exercise capacity is reduced among heart transplant recipients, and age is the strongest determinant of aerobic performance. Specific transplant-related factors, including TxCAD, do not contribute significantly to the explanation of exercise capacity. However, the occurrence of TxCAD may contribute to reduced exercise capacity during follow-up, since peak VO2 appears to decline only among those who have TxCAD.

Coronary Angiography↗
PubMed2004

Peak VO2 and VE/VCO2 slope in patients with heart failure: a prognostic comparison.

BACKGROUND: Exercise testing with ventilatory expired gas analysis has proven to be a valuable tool for assessing patients with heart failure (HF). Peak oxygen consumption (peak VO2) continues to be considered the gold standard for assessing prognosis in HF. The minute ventilation--carbon dioxide production relationship (VE/VCO2 slope) has recently demonstrated prognostic significance in patients with HF, and in some studies, it has outperformed peak VO2. METHODS: Two hundred thirteen subjects, in whom HF was diagnosed, underwent exercise testing between April 1, 1993, and October 19, 2001. The ability of peak VO2 and VE/VCO2 slope to predict cardiac-related mortality and hospitalization was examined. RESULTS: Peak VO2 and VE/VCO2 slope were demonstrated with univariate Cox regression analysis both to be significant predictors of cardiac-related mortality and hospitalization (P <.01). Multivariate analysis revealed that peak VO2 added additional value to the VE/VCO(2) slope in predicting cardiac-related hospitalization, but not cardiac mortality. The VE/VCO2 slope was demonstrated with receiver operating characteristic curve analysis to be significantly better than peak VO2 in predicting cardiac-related mortality (P <.05). Although area under the receiver operating characteristic curve for the VE/VCO2 slope was greater than peak VO2 in predicting cardiac-related hospitalization (0.77 vs 0.73), the difference was not statistically significant (P =.14). CONCLUSIONS: These results add to the present body of knowledge supporting the use of cardiopulmonary exercise testing in HF. Consideration should be given to revising clinical guidelines to reflect the prognostic importance of the VE/VCO2 slope in addition to peak VO2.

Analysis of Variance↗
PubMed2004

The use of RADAAR (ratio of rim area to disc area asymmetry) in detecting glaucoma and its severity.

BACKGROUND: In a previous study it was shown that the asymmetry of rim area and disc area of fellow eyes expressed as a ratio (rim area to disc area asymmetry ratio [RADAAR]) was associated with the diagnosis of glaucoma in patients with highly asymmetric disease. Furthermore, this ratio was able to distinguish these patients from groups of glaucoma suspects and subjects without glaucoma. The purpose of this study was to investigate whether the RADAAR correlates with the diagnosis and severity of glaucoma in a large glaucomatous population. METHODS: We reviewed the records of 140 randomly selected patients with open-angle, normal-tension or pseudoexfoliative glaucoma evaluated at the glaucoma service of a tertiary care centre in Philadelphia between January 1996 and April 2000. Heidelberg Retina Tomograph (HRT) disc area, rim area, cup-to-disc area ratio, pattern-standard deviation and mean deviation as well as maximum intraocular pressure (IOP) were recorded. Disc staging and visual fields determined severity of glaucoma, and fellow eyes were classified as "better" or "worse." RESULTS: The RADAAR was significantly correlated with IOP (r = 0.23, p < 0.03), mean deviation (r = -0.22, p < 0.02), cup-to-disc area ratio (r = 0.19, p < 0.03) and disc stage of glaucomatous optic nerve damage (r = 0.17, p < 0.05) in "worse" eyes. RADAAR groups were also correlated with fellow-eye differences in mean deviation (p < 0.05) and cup-to-disc area ratio (p < 0.02). INTERPRETATION: The RADAAR, a new HRT-derived measure of asymmetry in fellow eyes, is associated with the diagnosis of glaucoma and its severity.

Diagnostic Techniques, Ophthalmological↗
PubMed2004

Effect of age and end point on the prognostic value of the exercise test.

BACKGROUND: The clinical and exercise test variables chosen for predicting prognosis vary in the available studies. This could be due to the effect of age of the patients tested and the choice of outcomes used as end points in these follow-up studies. OBJECTIVE: To evaluate the effect of age and end points on exercise test variables chosen as significantly and independently associated with time to death. METHODS: Analyses were performed on the first treadmill test performed on consecutive male veterans at the Palo Alto and Long Beach Veterans Affairs Medical Centers since 1987. After removal of patients with congestive heart failure, coronary interventions, left bundle-branch block, atrial fibrillation, myocardial infarction and/or Q wave, and digoxin use, 3,745 male subjects remained. The outcomes were cardiovascular and all-cause mortality. The study population was divided into subsets according to age; exercise test and clinical variables were analyzed within the age subsets using the Cox hazard model. RESULTS: The mean age at the time of testing was 57 +/- 12 years (+/- SD) and they were followed up for a mean of 6.6 years. There were 544 all-cause deaths, with 206 of the deaths being due to cardiovascular causes (38%). When the study group was classified into subsets based on age, exercise capacity (in metabolic equivalents [METs]) was chosen by the Cox hazard model most consistently in the age groups using either end point. Even when age was added to the Duke treadmill score, prediction of death did not improve in those > 70 years of age because of the nonlinear relationship between age, the exercise test variables, and time to death. The most important age cut points for clinically important differences in exercise test predictors appeared to be 70 years and 75 years of age. In the patients 70 to 75 years of age, peak METs was the only variable predictive of all-cause mortality, and exercise-induced ST-segment depression was the only predictor of cardiovascular death; in the patients > 75 years of age, none of the exercise test responses were predictive of either death outcome. CONCLUSION: Both age and the outcome selected as an end point affect the exercise test responses chosen for scores to predict prognosis. Differences in age of the subjects tested and/or the outcome selected as the end point can explain the differences in the studies using exercise testing to predict prognosis.

Adult↗
PubMed2004

Optimizing the clinical exercise test: a commentary on the exercise protocol.

The exercise test has a high yield of diagnostic, prognostic, and functional information and continues to have an integral place in cardiovascular medicine. Its two most common clinical uses are to estimate the probability of a patient having coronary disease and to estimate the likelihood of future coronary events. Although recent guidelines for exercise testing have recommended that the exercise protocol should be adjusted for each patient, this is often overlooked. This review examines the use of the exercise test and discusses which protocols are most appropriate for which patients. Appropriate attention given to exercise testing methodology, including the choice of the exercise protocol, can help to assure the maximum functional, diagnostic, and prognostic yield of information.

Clinical Protocols↗
PubMed2003

The effect of ethnicity on survival in male veterans referred for electrocardiography and treadmill testing.

BACKGROUND: Ethnic differences in the relationship between access to health care and survival are difficult to define because of many confounding factors, such as socioeconomic status and baseline differences in health. Because the Veterans Affairs health care system offers health care largely without financial considerations, it provides an ideal setting in which to identify and understand ethnic differences in health outcomes. Previous studies in this area have lacked clinical and cardiovascular data with which to adjust for baseline differences in patients' health. METHODS: Data were collected from consecutive men referred for resting electrocardiography (ECG) (n = 41 087) or exercise testing (n = 6213) during 12 years. We compared ethnic differences in survival between whites, blacks, and Hispanics after considering baseline differences in age and hospitalization status. We also adjusted for electrocardiogram abnormalities and cardiac risk factors, exercise test results, and cardiovascular comorbidities. RESULTS: White patients tended to be older and had more baseline comorbidities and cardiovascular interventions when they presented for testing. White patients had increased mortality rates compared with blacks and Hispanics. In the ECG population, after adjusting for demographics and baseline electrocardiogram abnormalities, Hispanics had improved survival compared with whites and blacks. In the exercise test population, after adjusting for the same factors, as well as adjusting for the presence of cardiovascular comorbidities, cardiac risk factors, and exercise test findings, Hispanics also exhibited improved survival compared with the other 2 ethnicities. There were no differences in mortality rates between whites and blacks. CONCLUSION: Our findings demonstrate that the health care provided to veterans referred for routine ECG or exercise testing is not associated with poorer survival in ethnic minorities.

Aged↗