Application of 2011 American College of Cardiology Foundation/American Society of Echocardiography Appropriateness Use Criteria in Hospitalized Patients Referred for Transthoracic Echocardiography in a Community Setting

Ballo, Piercarlo; Bandini, Fabrizio; Capecchi, Irene; Chiodi, Leandro; Ferrò, Giuseppe; Fortini, Alberto; Giuliani, Gabriele; Landini, Giancarlo; Laureano, Raffaele; Milli, Massimo; Nenci, Gabriele; Pizzarelli, Francesco; Santoro, Giovanni Maria; Vannelli, P; Cappelletti, Carlo; Zuppiroli, Alfredo

doi:10.1016/j.echo.2012.03.006

Cited by 67 publications

(52 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our definition of impact is different from previous larger impact studies, undertaken either in tertiary settings or in community hospitals with specialised cardiology services. [12,13] A few older studies done at district hospitals either reviewed the impact more than 30 years ago, using only Mmode ECHO, or focused on intensive care units. [3,15,16] The lack of generalisability to current district hospital practice seems obvious, especially in resourceconstrained settings.…”

Section: Discussionmentioning

confidence: 99%

“…[12,13] The diversity of patients' ages, comorbidities and sources of referral revealed the broad value of this investigative modality. The value of a prospective study is that single ECHO assessment in a nontertiary setting can immediately address a focused, clinical question or suspicion raised, and may have an immediate impact.…”

Section: Discussionmentioning

confidence: 99%

“…[1] As a 'special' investigation it has the potential to pro vide accurate haemodynamic as well as anatomical information noninvasively at the bedside. [13] Developing countries are showing a steady rise in noncommuni cable diseases (NCDs), with cardiovascular diseases proving the largest burden in South Africa (SA). [4,5] The dual burden of communicable diseases and NCDs is disproportionately affecting vulnerable lower income groups in urban settings.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Impact of transthoracic echocardiography at district hospital level

et al. 2015

View full text Add to dashboard Cite

Background. The use of and demand for echocardiography (ECHO) has increased worldwide. In developed countries, this has not translated into improved access outside tertiary centres. Previous studies have favoured the appropriate use of ECHO over its clinical impact, limiting generalisability to resourceconstrained settings. Objectives. To assess the impact of an ECHO service at district hospital level in Cape Town, South Africa. Methods. A prospective, crosssectional study was performed. A total of 210 consecutive patients, referred to the ECHO clinic over a 5month period, were recruited. Transthoracic ECHO was evaluated in terms of its indication, new information provided, correlation with the referring doctor's diagnosis and subsequent management plan. Impact included the escalation and deescalation of treatment, as well as usefulness without a change in management. Results. The results show that 83.8% of the patients' management was impacted on by echocardiography. Valvular lesions were the main indication. The most frequent contribution was information provided towards the diagnosis of heart failure and assessment after myocardial infarction. Of the echocardiograms, 56.2% confirmed the referring doctor's diagnosis, yet were still associated with a significant impact. The rational prescription of medication had the major impetus, followed by deescalation of therapy and screening patients to determine referral to a tertiary facility. Conclusion. ECHO has a positive impact on patient management outside tertiary settings, where the definition of impact appears to be different. The value of a normal study, screening prior to upstream referral and usefulness irrespective of change have been established. This should alert policy makers against restriction of access to ECHO and promote training of personnel in its use.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Impact of transthoracic echocardiography at district hospital level

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Our approach has been to base this around the indications which generate the greatest numbers of inappropriate tests in the 2011 AUC for echocardiography (TTE and TEE, but not including stress, Figure 2) [15]. These are related to routine surveillance, evaluation of symptoms without other symptoms/signs of cardiac disease and low pretest probability of endocarditis [18,20,21,23,33,34,36,41]. Other situations include a suspicion of pulmonary embolism, when the exam would not change management, and when a test is ordered by non-cardiologists.…”

Section: Screening Imaging Requests For Appropriatenessmentioning

confidence: 99%

How I do it: judging appropriateness for TTE and TEE

Fonseca

Marwick

2014

Cardiovasc Ultrasound

View full text Add to dashboard Cite

The increasing cost of healthcare is a widespread international problem to which the cost of imaging has been an important contributor. Some imaging tests are ordered inappropriately and contribute to wasted use of resources. Appropriate use criteria have been developed in the USA in order to guide test selection, but there are a number of problems, including the evidence base for these criteria and the steps that can be taken to change physician practice. A restrictive approach to test ordering is difficult to fit to the nuances of clinical presentation and may compromise patient care. We propose an alternative approach to physician guidance based on the most common markers of inappropriate testing.

show abstract

“…Existen datos que indican que la rentabilidad diagnóstica de la ETT va estar influida por su categorización en apropiada, incierta o inapropiada, de tal forma que la probabilidad de encontrar hallazgos patológicos o con impacto sobre las decisiones clínicas resultará mayor en los estudios apropiados 4 .…”

Section: Introductionunclassified