Contributions and Limitations of the Stress Test on the Prediction of Cardiovascular Events in a High-risk Firefighter Population

The professional practice of firefighting presents risks specific, especially cardiovascular. In the United States 30% of Firefighter deaths are the result of a myocardial infarction that occurred while on duty. Certain occupational tasks expose firefighters to a higher risk of myocardial infarction (high physical load, inhalation of products). There is no recommendation on how to assess cardiovascular risk in French firefighters. In the absence of consensus, the Loire Departmental Fire and Rescue Service has constructed a scale for collecting cardiovascular risk factors (expert working group) to identify firefighters at high cardiovascular risk. A maintenance visit (mandatory every two years until the age of 38 and then once a year) is the best way to assess this cardiovascular risk, with a biological assessment and an electrocardiogram after the age of 40. If cardiovascular risk factors are present and the cardiovascular risk is high, the resting electrocardiogram should be supplemented by an exercise test. An exercise test can directly or indirectly quantify the endurance capacities of firefighters and reveal cardiac abnormalities sometimes absent at rest. Half of all myocardial infarctions occur without any prior symptomatology and remain totally asymptomatic, discovered during routine examinations. If the risk of myocardial infarction in activity is widely demonstrated to date for firefighters, and the realization of a stress test in those at high cardiovascular risk included in the practice habits, no study has evaluated the contributions and limits of the realization of a stress test in this specific population of firefighters at high cardiovascular risk for the prediction of cardiovascular events.