Department of Internal Medicine E, Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Tel-Aviv, Israel.
J Gen Intern Med. 2009 Aug;24(8):934-8. doi: 10.1007/s11606-009-1029-2.
The present study, using a decision analysis, evaluates whether an exercise tolerance test (ETT) is indicated before initiating regular physical activity to reduce the risk of sudden death during exercise training.
The study encompasses a decision tree, Monte Carlo simulation, and utility analysis for adults at low to high risk for coronary disease, with a time horizon of five years, with or without routine ETT screening before initiating physical activity.
Mortality in Monte Carlo simulation; expected values in utility analysis.
Routine screening decreases mortality in intermediate to high-risk populations but not in low-risk persons. At all risk levels, the number of exercise-induced deaths prevented is less than the added number of deaths from angiography. Utility analysis indicates inferiority of routine screening, regardless of risk. Personal preferences (perceived stigma from having coronary disease and perceived benefit of regular exercise on quality of life) have a strong influence on the optimal choice.
Routine screening before initiating regular exercise is not recommended for the purpose of reducing the risk of sudden death during exercise training.
本研究采用决策分析方法，评估在开始常规体力活动前是否需要进行运动耐量试验（ETT），以降低运动训练期间猝死的风险。
本研究包括决策树、蒙特卡罗模拟和对低危至高危冠心病成人的效用分析，时间范围为五年，包括或不包括在开始体力活动前进行常规 ETT 筛查。
蒙特卡罗模拟中的死亡率；效用分析中的预期值。
常规筛查可降低中高危人群的死亡率，但对低危人群无效。在所有风险水平下，运动引起的死亡人数减少量均低于因血管造影而增加的死亡人数。效用分析表明，无论风险如何，常规筛查都较差。个人偏好（对患冠心病的耻辱感和定期运动对生活质量的益处的感知）对最佳选择有很大影响。
不建议为降低运动训练期间猝死的风险而在开始常规运动前进行常规筛查。
