# Re-thinking the Role of Stress Imaging for Symptomatic Older Adults with Stable Coronary Artery Disease

> **NIH NIH R03** · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · 2024 · $169,000

## Abstract

PROJECT SUMMARY/ABSTRACT
More than a quarter of all adults older than 75 years have symptomatic stable ischemic heart disease. Stress
nuclear imaging is the one of the most common tests performed for diagnosis and management of coronary
artery disease in these older adults. Older adults are more likely to have co-existing impairments in function,
cognition and multimorbidity, which may limit their benefit from imaging tests and post-test treatment, alike.
Although stress testing is often used to evaluate symptoms, clinicians are less likely to refer older adults for
revascularization or to optimize their medical therapy, even if stress test results are severely abnormal. In turn,
this can result in overuse of testing, increased complications and cost of care without improving patient
outcomes. To help older patients presenting with suspected ischemic symptoms make a well-informed
decision, clinicians should contextualize the benefits of imaging and treatment strategies post imaging in
context of elicited goals of care, clinical
impairments. It is critical to understand
presentation, cardiac risk factors and potential age-related
how to improve shared decision making among older adults and identify
areas of imaging test overuse or underuse among older adults with symptomatic stable ischemic heart
disease.
In this project, I use a multi-stakeholder approach to understand post-stress test decision making from patient,
caregiver and physician perspectives and study its association with outcomes among symptomatic older adults
with suspected or known CAD. My research aims are to (a) understand older patient and caregiver attitudes
about post-imaging treatment choice in context of their preferred outcomes and age-related impairments
through focus group interviews and (b1) examine the association between cardiovascular and geriatric risk
factors on post-imaging treatment choice (i.e., invasive referral vs. medical optimization); and (b2) compare the
association of treatment received post-imaging and patients' symptoms, function and quality of life among
symptomatic older adults  75 years undergoing clinically indicated stress nuclear imaging within our health
system. This study will help inform my future work aimed at developing and testing personalized decision aids
to guide choice of testing and treatment for symptomatic older adults with CAD. This GEMSSTAR award will
also provide me with the support, mentorship and training required to become a leader in field of
cardiovascular imaging and shared decision-making for older adults with stable ischemic heart disease.

## Key facts

- **NIH application ID:** 10906976
- **Project number:** 5R03AG082994-02
- **Recipient organization:** ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
- **Principal Investigator:** Krishna Kaushik Patel
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $169,000
- **Award type:** 5
- **Project period:** 2023-08-15 → 2026-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10906976

## Citation

> US National Institutes of Health, RePORTER application 10906976, Re-thinking the Role of Stress Imaging for Symptomatic Older Adults with Stable Coronary Artery Disease (5R03AG082994-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10906976. Licensed CC0.

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