1. Why Perform
Non-Invasive
ANS Testing?
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2. Why Test?
CCA Testing Helps Decrease Mortality Rates.
• Cardiovascular autonomic neuropathy occurs in about 17% of patients with
type 1 diabetes and 22% of those with type 2 diabetes.
• Of patients with symptomatic autonomic dysfunction, 25% to 50% die within 1
to 5 years of diagnosis.
Why are Mortality Rates so High?
• Reduced parasympathetic function or increased sympathetic activity may
provide the propensity for lethal arrhythmias.
• Silent ischemia and silent MI are particularly dangerous because patients
cannot sense the pain and seek help. One study found a mortality rate after
asymptomatic MI of 47%.
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3. Exercise Intolerance
“...there is clinical evidence demonstrating abnormalities in
left ventricular function in response to diabetics without
coronary artery disease, particularly among those with
autonomic neuropathy”1.
“This kind of vascular dysfunction could participate in the
pathogenesis of progressive left ventricular dysfunction even
in diabetics with angiographically normal coronary arteries” 2.
1,2- Circulation 1999;100;813-819
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4. Exercise Intolerance
“Cardiac autonomic function testing should be
performed when planning an exercise program for
individuals with diabetes about to embark on a
moderate to high-intensity exercise program..”
- 2005 ADA Standard of Diabetes Care
“For diabetic persons likely to have CAN, it has been
suggested that cardiac stress testing should be performed
before beginning an exercise program”.
-Circulation 2007;115;387-397
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5. ADA Recommendations
“A patient’s history and physical examination are
ineffective for early detection of CAN, and therefore
noninvasive tests that have demonstrated efficacy are
required.”
“Screening for Autonomic Neuropathy should be
instituted at Diagnosis of Type 2 Diabetes and 5 years
after the diagnosis of type 1 Diabetes.”
- 2005 ADA Standard of Diabetes Care
“Although it can cause severe cardiovascular problems and
sudden death, surveys show that only 2% of people with
diabetes are tested for cardiovascular autonomic
neuropathy (CAN).”
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6. Autonomic Balance Testing is
Considered a Standard of Care
American Diabetes Association
“Given the clinical and economic impact of this complication,
testing of diabetic individuals for cardiovascular autonomic
dysfunction should be part of their standard of care”
DIABETES CARE, VOLUME 26, NUMBER 5, MAY 2003 1579
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7. Autonomic Balance Testing is
Considered a Standard of Care
American Diabetes Association
“Consensus statement sponsored by the ADA and AAN was a synthesis of
reviewed research efforts to date in the clinical assessment of
neuropathies and offered recommendations for testing of diabetic
neuropathy (including autonomic neuropathy)...
Specifically concerning the assessment of CAN, the panel recognized
strong evidence for the three tests of heart rate control. The three tests
recommended were heart rate response to
1) deep breathing, 2) standing, and 3) the Valsalva maneuver.
DIABETES CARE, VOLUME 26, NUMBER 5, MAY 2003 1579
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8. Autonomic Balance Testing is
Considered a Standard of Care
American Academy of Neurology
“Consensus on the usefulness of tests of autonomic function exists for a
number of disorders and conditions. These tests, in general, are definable
in terms of their ability to diagnose a condition, to provide unique
differential diagnostic information, or to quantify those aspects of
autonomic function that have an impact on outcome or
Evaluate treatment efficacy”
Published in Neurology 1996;46:873-880.
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9. Physician Benefits
• Test is administered by MA or tech. Testing takes only 15
minutes to run a full battery of tests including cardiovascular
fitness assessment. The individual test modules take as little as
6 to 10 minutes.
• Interpretive reports are generated immediately after testing.
• The reports are very easy to read, understand and include
additional details and graph options for the physician.
• Increased patient care and retention by providing
comprehensive health analysis for early detection, prevention
and intervention.
• Increased practice revenue. CCA test is approved and
reimbursable by most insurance carriers (public & private).
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10. Sample Reports
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11. Who to Test ?
• Diabetics
• High Risk
• Patients that suffer or have experience with: Migraine, headaches,
depression, fibromyalgia, anxiety, panic attacks, insomnia, dizziness,
lightheadedness, fainting, blurry vision, spots before eyes, tingling in
fingers, chest pain, back pain or apathy.
• Patients diagnosed with: Diabetes, Cancer, Asthma, High Blood Pressure,
Low Blood Pressure, High Cholesterol, Heart Attack, Congestive Heart
Failure, Arteriosclerosis, Atherosclerosis, Hardening of the arteries, Sleep
Disorders, Eating Disorders, Parkinson's Disease, Crohn's Disease, Cystic
Fibrosis, Angina, Muscular Dystrophy, Sleep Apnea, Cardiomyopathy,
Irritable Bowel Syndrome, Thyroid Problems, Iron Deficiency Anemia and
more…
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