Stress Tests-Reply

In Reply.—  I agree that the use of stress tests (and all other diagnostic tests) should be reserved for those circumstances in which the usefulness of the test has been established. However, as has been pointed out,¹ it is seldom clear which clinical groups have been adequately evaluated. Consequently, any use of the stress test constitutes an educated guess based on the clinician's knowledge of the literature, what he has been told by other physicians, his personal experience, and the patient's clinical characteristics. For example, in studying a patient taking a β-blocker, a clinician may reasonably conclude that a positive stress test result provides useful information while a negative test result is unhelpful, particularly if the target heart rate was not achieved. He then must use his knowledge and experience to decide what the test results mean for his patient.The calculations of Epstein² and Diamond and Forrester