Appropriate use criteria in clinical routine practice: implications in a nuclear cardiology lab

The efforts for a broad application of the appropriate use criteria to reduce inappropriate nuclear stress testing have frequently been unsuccessful and the reported rates of inappropriateness have varied widely between studies. We sought to analyze the criteria of clinical appropriateness of a coho...

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Bibliographic Details
Published in:The International Journal of Cardiovascular Imaging 2016-06, Vol.32 (6), p.1003-1009
Main Authors: Gimelli, Alessia, Rovai, Ilaria, Liga, Riccardo, Pasanisi, Emilio Maria, Marzullo, Paolo
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Cardiac Imaging
Cardiology
Clinical Laboratory Techniques - standards
Clinical Laboratory Techniques - utilization
Female
Guideline Adherence
Humans
Imaging
Italy
Male
Medicine
Medicine & Public Health
Middle Aged
Myocardial Ischemia - diagnostic imaging
Myocardial Ischemia - physiopathology
Myocardial Perfusion Imaging - methods
Myocardial Perfusion Imaging - standards
Myocardial Perfusion Imaging - utilization
Original Paper
Patient Selection
Practice Guidelines as Topic
Predictive Value of Tests
Prognosis
Radiation Dosage
Radiation Exposure - prevention & control
Radiology
Retrospective Studies
Severity of Illness Index
Tomography, Emission-Computed, Single-Photon - standards
Tomography, Emission-Computed, Single-Photon - utilization
Unnecessary Procedures
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Summary:The efforts for a broad application of the appropriate use criteria to reduce inappropriate nuclear stress testing have frequently been unsuccessful and the reported rates of inappropriateness have varied widely between studies. We sought to analyze the criteria of clinical appropriateness of a cohort of consecutive patients referred to our nuclear cardiology laboratory to perform stress myocardial perfusion imaging (MPI) and to assess the relationships between test appropriateness and the evaluation of ischaemia. A cohort of 251 consecutive patients, admitted to our Institute from January to March 2015, who underwent stress/rest MPI on a dedicated cardiac camera equipped with cadmium–zinc–telluride detectors, was selected. The level of clinical appropriateness of each MPI test was categorized in each patient according to the AUC criteria. According to the accepted criteria, the majority of the MPI stress-tests could be classified as clinically appropriate (218 of 251, 87 % of the tests), while only 16 (6 %) and 17 (7 %) resulted of uncertain appropriateness or clearly inappropriate, respectively. Of the 251 appropriate tests, 22 (10 %), 65 (30 %), and 131 (60 %) showed the presence of a mild (SDS 
ISSN:1569-5794
1573-0743
1875-8312
DOI:10.1007/s10554-016-0864-6