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Advanced Cardiopulmonary Exercise Testing at Brigham and Women's Hospital

Brian Simon

Arlene Schiro


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Conference: 2011 PH Professional Network Symposium

Release Date: 09.22.2011

Presentation Type: Abstracts

B. Simon, RN BSNA. Schiro, NP
Brigham and Women's Hospital, Boston, MA

PURPOSE: There exists a significant proportion of the population that experiences exertional dyspnea and or fatigue of unknown origin. These patients have usually been through a battery of tests to rule out more common diagnoses and are sometimes left with no explanation for the symptoms they are experiencing. This can be physically, emotionally and mentally disruptive to their lives and significantly impact their health status.

In the last few years, Advanced Cardiopulmonary Exercise Testing (A-CPET) at the Massachusetts General Hospital has helped to achieve a better understanding of how to test these patients and define the physiologic basis of their dyspnea. This type of testing was being done on about 150 patients a year at their institution and is now being offered at the Brigham and Women's Hospital.

The fact that A-CPET is a relatively new testing procedure leads to a several important questions.

  • What is the safest way to perform this test with available resources?
  • What is the most effective way to perform this test with available resources?
  • Are the results of the testing shown to improve the diagnosis and treatment of the patient?
  • Do the results and/or change of treatment result in a change in the patient's functional status and dyspnea?
  • How can we best track any complications of the procedure and modify the testing process to improve its use and effectiveness?
  • Can we develop a thorough and efficient protocol and quality assurance system as we expand the availability of the test and the testing process? As we promote this approach to the evaluation of the patient with unexplained dyspnea, we can also become a role model for educating the public and other institutions locally and nationally about the efficacy of this test.

BACKGROUND: In the past, patients typically undergo a series of tests to determine the cause of dyspnea. These tests may include pulmonary function tests, echocardiogram, cardiac stress, or exercise testing and right heart catheterization. All of these exams can be useful to rule out well known cardiac and pulmonary disorders. However, they are often inadequate in determining other causes of dyspnea.

The development of the invasive or "advanced cardiopulmonary exercise test" has lead to the diagnosis of Exercise Induced Pulmonary Artery Hypertension, Exercise Induced Heart Failure with preserved ejection fraction, and Pre-load Failure, and neurologic and muscular disorders such as oxidative myopathies. Each diagnosis is treated differently and, when treatment is available, can lead to improved functional status. In some cases, while there may be no treatment, having a diagnosis or explanation for what the patient is feeling, having validation of their symptoms or complaints, may in itself, lead to improved patient satisfaction.

METHOD

  • To consistently evaluate testing procedure to ensure safety and efficacy through routine team meetings with Cath Lab, Exercise Lab, and Pulmonary Teams. This could be done on a monthly basis.
  • To utilize a tool, such as the "Pulmonary Functional Status and Dyspnea Questionnaire", to evaluate dyspnea pre and post testing and change in treatment. This would involve tracking patients before the procedure and also 4 weeks and 6 months post procedure, as well as any complications from the test including bleeding or infection to see if nursing is being effective with their care of the access sites.
  • To evaluate patient satisfaction with the test as far as comfort and how they were treated physically and emotionally at our facility with regard to nursing as well as technical and medical staff.

FINDINGS: To be determined over the next year.

IMPLICATIONS: To provide a safe and effective way to diagnose unexplained dyspnea.