Dr. Robert A. Bruce, the cardiologist who devised the now ubiquitous treadmill stress test to assess heart disease, has died. He was 87.
Bruce died Thursday at the Ida Culver House, an assisted-living complex in Seattle, of leukemia and spinal stenosis.
"He's one of the heroes of cardiology. He set the standard for all of us," said Dr. Richard Page, who holds the Robert A. Bruce Chair in Medicine and is head of the University of Washington Division of Cardiology. Bruce held Page's job from its inception in 1950 until his retirement in 1982, and led development of the University of Washington into an international center of heart research.
Bruce, dubbed "the father of exercise cardiology," began his life's work more than half a century ago when he mused about assessing the condition of a used car simply by watching it idle in the dealer's lot. Surely, he thought, a prospective buyer could tell more by taking it for a spin.
And if that test drive worked for a car, he reasoned, why not for a human being? He used the electrocardiograph and the motorized treadmill developed in the 1940s to begin tests, wiring a patient to electrodes and an oxygen analyzer while the patient walked on a treadmill for 10 minutes.
Bruce published his first results of that single-stage test in 1949, and eventually developed a multistage treadmill examination. When he published the more detailed study in 1963, he established what became known as the Bruce Protocol as the most popular method of evaluating problem hearts.
His work eventually helped pave the way for major changes in treatment of heart patients from mere bed rest after heart attacks in the 1940s to today's surgical bypasses, balloon angioplasty, insertion of stents and artificial hearts.
Before Bruce's development of his "body test drive," doctors had used EKGs only when a patient was lying at rest. Some doctors, using a test devised in 1935 by Dr. Arthur M. Master, had patients step on and off a platform for 90 seconds between EKGs. Unfortunately, many heart patients were unable to complete the so-called Master's Two-Step, thus reducing the usefulness of the evaluation.
Bruce's standardized treadmill test measured cardiorespiratory performance as the patient walked at speeds and inclines that were increased every three minutes. The test, his research showed, could detect signs of such conditions as angina pectoris (chest pains), a previous heart attack or a ventricular aneurysm (bulging in a section of the heart).
The pioneering Bruce, seeing which problems were caused by mere aging and which by disease, established that exercise testing could be used to screen seemingly healthy people for early signs of coronary artery disease.
In addition, from 1971 to 1981, Bruce and colleague Dr. Harold T. Dodge conducted the Seattle Health Watch. The study involved administering treadmill tests and follow-up questionnaires to thousands of Seattle-area workers, including those at Boeing. It showed that treadmill testing was safe and a powerful diagnostic tool when coupled with family history and lifestyle factors including smoking. Employers, as well as hospitals and clinics, began using Bruce's test to screen workers.
In the Health Watch study, Bruce also found something he hadn't expected -- that taking a treadmill test motivated people to change bad habits such as smoking or lack of exercise.
Born in Boston and reared in suburban Somerville, Mass., Robert Arthur Bruce earned his bachelor's degree at Boston University and medical degree at the University of Rochester. He taught there for four years before going to Seattle in 1950.
Bruce was a founder and former president of the Assn. of University Cardiologists and a fellow of the American College of Cardiology.
Practicing what he preached about the value of exercise to good health, he continued to walk a mile a day almost until his death. To keep his mind active and for entertainment, he was taking an advanced calculus class.
Widowed twice, Bruce is survived by his wife of 20 months, Barbara Klemka; three sons, Peter, Robert and Scott; five stepchildren, John and Stuart Laughlin, Carole Brennan, Donna Klemka and Judith Coryell; four grandchildren; and one great-granddaughter.
Services are planned for Friday in Seattle. The family has asked that any memorial donations be made to the Cardiology Fellows Resource Center, University of Washington Division of Cardiology, P.O. Box 356422, 1959 N.E. Pacific St., Seattle, WA 98195.