The prognostic value of exercise testing in elderly men

Purpose Our purposes were to compare the responses to exercise testing in elderly (≥65 years of age) and younger men, and to investigate whether exercise testing has similar prognostic value in the two age groups. Methods We included all elderly (n = 1185) and younger (n = 2789) male veterans without established coronary heart disease who underwent routine clinical exercise testing between 1987 and 2000 at two academically affiliated Veteran’s Affairs medical center laboratories. Measurements included a standardized medical history, exercise testing, and all-cause mortality. Results Compared with younger patients, elderly patients achieved a lower workload (a mean [± SD] of 7 ± 3 vs.10 ± 4 metabolic equivalents [METs], P<0.001) and were more likely to have abnormal ST depression (27% [n = 324] vs. 16% [n = 436], P<0.001). During the mean follow-up of 6 years, annual mortality was twice as high among elderly patients as among younger patients (4% vs. 2%, P<0.001). The only exercise test variable that was associated significantly with time to death in both age groups was maximal METs achieved: each 1 MET increase in exercise capacity was associated with an 11% reduction in annual mortality. Exercise-induced ST depression was more common in those who subsequently died, but was not an independent predictor of mortality. Conclusion In elderly men, exercise testing provided prognostic information incremental to clinical data. Achieved workload (in METs) was the major exercise testing variable associated with all-cause mortality. Its prognostic importance was the same in elderly as in younger men.