Tabriz University of Medical Sciences Journal of Cardiovascular and Thoracic Research 2008-5117 11 4 2019 11 11 Adherence to American Heart Association and American College of Cardiology guidelines for exercise tolerance test in cardiovascular clinics 305 308 10.15171/jcvtr.2019.49 EN Nahid Hatam https://orcid.org/0000-0001-7738-1970 Vida Razazi Khales Mehrdad Askarian Abdolali Zolghadrasli Shohre Hooshmand Mohammadali Ostovan https://orcid.org/0000-0001-9068-014X Journal Article 10.15171/jcvtr.2019.49 2019 05 28 2019 08 25 Introduction: Considering the increased expenditure in public health sector, especially the increased cost in hospitals and clinics, there is an urgent need to control these costs mainly by ensuring adherence to clinical guidelines for diagnostic procedures. In this study we aim to investigate the adherence of heart clinics to guideline for exercise tolerance test. Methods: This cross-sectional study was performed on 308 patients who were referred for ECG exercise test in 3 clinics located in the city of Shiraz, Iran in 2018. Demographic and clinical data were recorded and the indications of exercise test for each patient was reviewed according to the ACC/AHA guideline for exercise tolerance test. Results: Exercise tests were found to be inappropriately done in 121 (39.3%) participants. Among the patients for whom the test was done without indication 79 (65.3%) were women and the gender difference was statistically significant (P < 0.01); women were 18.5% more likely to undergo exercise test without indication. There was more inappropriate tests among nonanginal pain subsets comparing to other presenting symptoms (P < 0.001). Age, coronary risk factors, reason for performing exercise tests and private health system were not predictors of inappropriate use (P > 0.05). Conclusion: This study confirms that more than one third of exercise tests done in the participants are inappropriate. Wide availability of exercise test makes it vulnerable to overuse and additional unnecessary cost to health care systems.