Sico, Jason J.Baye, FitsumMyers, Laura J.Concato, JohnFerguson, JaredCheng, Eric M.Jadbabaie, FaridYu, ZhangshengArling, GregoryZillich, Alan J.Reeves, Matthew J.Williams, Linda S.Bravata, Dawn M.2019-05-092019-05-092018-06Sico, J. J., Baye, F., Myers, L. J., Concato, J., Ferguson, J., Cheng, E. M., … Bravata, D. M. (2018). Receipt of cardiac screening does not influence 1-year post-cerebrovascular event mortality. Neurology. Clinical practice, 8(3), 192–200. doi:10.1212/CPJ.0000000000000465https://hdl.handle.net/1805/19206Background: American Heart Association/American Stroke Association expert consensus guidelines recommend consideration of cardiac stress testing to screen for occult coronary heart disease (CHD) among patients with ischemic stroke/TIA who have a high-risk Framingham Cardiac Risk Score (FCRS). Whether this guideline is being implemented in routine clinical practice, and the association of its implementation with mortality, is less clear. Methods: Study participants were Veterans with stroke/TIA (n = 11,306) during fiscal year 2011 who presented to a VA Emergency Department or who were admitted. Patients were excluded (n = 6,915) based on prior CHD/angina/chest pain history, receipt of cardiac stress testing within 18 months prior to cerebrovascular event, death within 90 days of discharge, discharge to hospice, transfer to a non-VA acute care facility, or missing/unknown race. FCRS ≥20% was classified as high risk for CHD. ICD-9 and Common Procedural Terminology codes were used to identify receipt of any cardiac stress testing. Results: Among 4,391 eligible patients, 62.8% (n = 2,759) had FCRS ≥20%. Cardiac stress testing was performed infrequently and in similar proportion among high-risk (4.5% [123/2,759]) vs low/intermediate-risk (4.4% [72/1,632]) patients (adjusted odds ratio [aOR] 0.77, 95% confidence interval [CI] 0.54-1.10). Receipt of stress testing was not associated with reduced 1-year mortality (aOR 0.59, CI 0.26-1.30). Conclusions: In this observational cohort study of patients with cerebrovascular disease, cardiac screening was relatively uncommon and was not associated with 1-year mortality. Additional work is needed to understand the utility of CHD screening among high-risk patients with cerebrovascular disease.en-USAttribution-NonCommercial-NoDerivs 3.0 United StatesCardiac stress testingOccult coronary heart diseaseFramingham Cardiac Risk ScoreIschemic stroke/TIAArticle