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Abstract
Background CPET has been extensively used in the pre-operative (general anaesthesia) risk stratification. More recently, the utility of CPET has become more defined in the evaluation of unexplained dyspnoea and in prognosticating pulmonary hypertension in a rational manner which is also less invasive for patients. We set out to evaluate the utilisation pattern of CPET within a 709-bedded central England acute hospital Trust spread across 3 sites in the second year of the establishment of the service.
Methods The source of referral (and reason) for CPET were retrospectively recorded and analysed between 01 July 2013 and 31 May 2014 (ten months).
Results The total number of CPET referrals received was 178 out of which 150 (84%) were from surgical disciplines and 28 (16%) from medical disciplines. Vascular surgery submitted made the majority of referrals (108, 61%) followed by colorectal surgery [see Figure]. Respiratory Medicine was the source of 11% of all referrals and Cardiology the source of 4%.
Conclusions The dominant utilisation of CPET by vascular surgery is expected, given the NHS evidence adoption centre and National Institute for Health and Care Excellence (NICE) 2009 recommendations on risk-stratification for Abdominal Aortic Aneurysm surgery mortality. However, CPET offers a unique assessment tool for the investigation of patients with unexplained dyspnoea and has a potential to pre-empt invasive, unnecessary and expensive assessment without definitive diagnosis [Thing JER, Mukherjee B, Murphy K et al. Thorax 2011; 66 (4): A144]. It appears that a lot of work needs to be done among the UK general respiratory and cardiology/heart failure communities to promote the awareness, understanding and utilisation of CPET.
CPET Service Utilisation