ACCF/ASE/ACEP/AHA/ASNC/SCAI/SCCT/SCMR 2008 Appropriateness Criteria for Stress Echocardiography

Abstract

The American College of Cardiology Foundation (ACCF) and the American Society of Echocardiography (ASE) together with key specialty and subspecialty societies, conducted an appropriateness review for stress echocardiography. The review assessed the risks and benefits of stress echocardiography for several indications or clinical scenarios and scored them on a scale of 1 to 9 (based upon methodology developed by the ACCF to assess imaging appropriateness). The upper range (7 to 9) implies that the test is generally acceptable and is a reasonable approach, and the lower range (1 to 3) implies that the test is generally not acceptable and is not a reasonable approach. The midrange (4 to 6) indicates a clinical scenario for which the indication for a stress echocardiogram is uncertain. The indications for this review were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Use of stress echocardiography for risk assessment in patients with coronary artery disease (CAD) was viewed favorably, while routine repeat testing and general screening in certain clinical scenarios were viewed less favorably. It is anticipated that these results will have a significant impact on physician decision making and performance, reimbursement policy, and will help guide future research.

Prognostic Implication of Appropriateness Criteria for Pharmacologic Stress Echocardiography Performed in an Outpatient Clinic

“…Moreover, this may have introduced a bias, particularly in the uncertain group of subjects, in whom the ambiguity of the indication was mirrored by a higher level of clinical risk, influencing outcome. Unlike 2 previous studies 17,28 that adopted 2008 appropriateness criteria for stress echo 30 reporting 12% and 19% of patients not classified, we addressed all the indications ordered in our clinical practice. The reduction of areas of uncertainties in the updated document, 12 differences in clinical scenarios, clinical information collected at the time of testing, and personnel reviewing the data may account for this, at least in part.…”

Comparação da adequação de solicitação de ecocardiograma entre hospitais público e privado

“…This study aims primarily at comparing the profile of adequacy of outpatient TTE requests, according to the score of appropriateness criteria (AC) 3 , carried out in a private hospital, with a public university hospital. Its secondary purpose is to verify which characteristics of hospitals and requesting physicians were associated with a better profile of TTE request.…”

Indicaciones actuales del ecocardigrama transtorácico

“…Recientes guías publicadas en marzo 2011 actualizan las previas, sobre criterios de uso (2) apropiado del ecocardiograma transtorácico y fundamentan la revisión de los diferentes escenarios clínicos en los cuales debe ser adecuada la solicitud del ecocardiograma. En base a ciertos métodos que combinan medicina basada en la evidencia y la experiencia clínica se presentan las recomendaciones actuales sobre las indicaciones apropiadas del (3) ecocardiograma transtorácico .…”

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ResumenRecientes guías publicadas en marzo 2011 actualizan las previas, sobre criterios de uso (2) apropiado del ecocardiograma transtorácico y fundamentan la revisión de los diferentes escenarios clínicos en los cuales debe ser adecuada la solicitud del ecocardiograma. En base a ciertos métodos que combinan medicina basada en la evidencia y la experiencia clínica se presentan las recomendaciones actuales sobre las indicaciones apropiadas del (3) ecocardiograma transtorácico .

Actualmente existen 98 indicaciones que fueron definidas por un grupo médico experto y de acuerdo al puntaje fueron consideradas de uso apropiado cuando la mayoría del grupo estuvo de acuerdo en su indicación, de uso incierto cuando la mitad del grupo estuvo de acuerdo, y

Revista Facultad -RFS -Enero-Junio 2013

73

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