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Seattle Heart Watch - Seattle Heart Watch
Description:
Community practice study of CAD, exercise testing, and risk factors.
Hypothesis:
Community practice study of coronary disease, maximal exercise testing, and risk factors.
Study Design
Study Design:
Patients Screened: Not given
Patients Enrolled: 4,158
Mean Follow Up: 6.1 years
Mean Patient Age: 46
Female: 13
Patient Populations:
Registered between 1971 and 1974 from the Seattle area.
Initially free of clinical coronary heart disease manifestations.
Primary Endpoints:
N/A
Principal Findings:
The Seattle Heart Watch included a 10 year prospective community practice study of symptom-limited maximal exercise testing (Bruce protocol). Initiated in 1971, it registered patients through 1974. Annual follow-up surveillance of subsequent coronary heart disease morbidity was maintained until 1981.
The study revealed a crude incidence of 202 coronary heart disease events, or 4.9% in 6.1 +/- 2.6 years of follow-up. The case fatality rate was 16.8%.
Patients were stratified prior to exercise testing into three groups: asymptomatic (61%), atypical chest pain syndrome (18%), and hypertensive (21%). The incidence rate of primary events due to coronary heart disease was 2.9%, 5.5% (not significant) and 10.0% (p less than 0.001), for the three groups, respectively.
The presence of any conventional risk factor, in conjunction with two or more selected maximal exercise predictors (which vary with the clinical classification) at enrollment, substantially increased the cumulative 6 year incidence rate to 24.3, 15.5 and 33.3% in asymptomatic healthy men, patients with atypical chest pain syndrome and hypertensive patients, respectively.
Interpretation:
Observation of the exercise predictors in the absence of conventional risk factors increased the risk much less, suggesting that the use of maximal exercise testing for risk assessment in those with no clinical manifestations of disease might be limited to persons with one or more conventional risk factors.
The Seattle Heart Watch included observational registries for other populations, including a 2616 patient registry for patients receiving angiography between 1969 and 1974, which has been used to evaluate surgical and medical treatment strategies for coronary disease. (Circulation 1979;59:430-5, Circulation 1982;65(7, Pt 2):53-9)
References:
1. Am J Cardiol 1974;33:459-69. Initial responses to max exercise
2. J Am Coll Cardiol 1983;2:565-73. Exercise testing - 10 year follow-up
Keywords: Coronary Artery Disease, Follow-Up Studies, Chest Pain, Risk Factors, Risk Assessment, Exercise Test
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