Does the Revised Appropriate Use Criteria for Echocardiography Represent an Improvement Over the Initial Criteria? A Comparison between the 2011 and the 2007 Appropriateness Use Criteria for Echocardiography

Prospective evaluation of the updated 2010 ACCF Cardiac CT Appropriate Use Criteria

“…6 Published evaluations of the performance of AUCs in other imaging modalities show that the rate of inappropriate indications generally accounts for %15% of imaging referrals. 7,8 Our findings for cardiac CT show a similar rate of inappropriate indications, 12.9%. Although the AUC update reduced the proportion of indications rated as inappropriate, the main changes were observed in the proportion of indications that could be rated and in the rate of uncertain indications.…”

“…A recent description of the effect of the updated echocardiography AUC shows similar findings with an increase in the rate of appropriate ratings and a significant reduction in indications that could not be classified. 8 AUCs reflect published evidence and medical opinion, but they differ from guidelines in their largely empiric nature. Yet the ongoing validation of AUCs must include a description of their relation to health care outcomes.…”

How I do it: judging appropriateness for TTE and TEE

“…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.…”

“…A very common situation in patients with nonspecific symptoms includes patients with lightheadedness/presyncope without other symptoms) [23,41]. Common valve-related indications include <3 year after prosthetic valve implantation in the absence of known or suspected valve dysfunction [33], and evaluation of infective endocarditis when there is transient fever without evidence of bacteremia [23] or new murmur or transient bacteraemia with a pathogen not typically associated with endocarditis. For transoesophageal echocardiography, the most common inappropriate indications are related to endocarditis with low pretest probability and routine use of TEE when a diagnostic TTE is reasonably anticipated to resolve all concerns [21].…”

The application of appropriate use criteria for transthoracic echocardiography in a cardiac intensive care unit

“…4,8 Appropriate use criteria currently exist for three types of echocardiographic imaging studies-transthoracic echocardiography (TTE), transesophageal echocardiography, and stress echocardiography-which have subsequently been validated in a number of different clinical settings, including outpatient cardiology clinics, outpatient preoperative anesthesia clinics, and inpatient medical units spanning a range of practice environments from community hospitals to quaternary-care academic centers. 5,[9][10][11][12][13][14][15][16][17][18][19][20][21][22] However, no study has evaluated the applicability of current AUC to TTEs performed in a cardiac intensive care unit (CICU), a particularly important clinical environment in which to implement AUC given unique diagnostic challenges encountered in a typical CICU and the resultant high volume of echocardiograms ordered in this patient population. We analyzed consecutive TTEs performed in a CICU at an urban quaternary-care academic medical center to ascertain the ability of AUC to classify the appropriateness of TTEs obtained in this setting.…”