What is the role of exercise testing in the management of stable angina in primary care?

Role of Exercise Testing in Stable Angina Management in Primary Care

Exercise testing (exercise ECG) may be used as a non-invasive functional test to help confirm the diagnosis of stable angina when clinical assessment alone cannot exclude it, particularly in people with confirmed coronary artery disease (CAD) or when there is uncertainty about whether chest pain is caused by myocardial ischaemia.

However, exercise testing is not routinely recommended as an initial diagnostic tool in primary care for recent-onset chest pain; instead, clinical assessment and resting 12-lead ECG are first steps.

Exercise ECG can be considered as an alternative to other functional imaging tests for myocardial ischaemia in people with confirmed CAD when further diagnostic clarity is needed.

In primary care, if stable angina symptoms are satisfactorily controlled with optimal medical treatment, further functional or non-invasive anatomical testing, which may include exercise testing, can be considered to identify people at high risk who might benefit from revascularisation.

Decisions about exercise testing and further investigations should be made using clinical judgement, considering patient preferences and comorbidities.