Prospective Evaluation of the Clinical Application of the American College of Cardiology Foundation/American Society of Echocardiography Appropriateness Criteria for Transthoracic Echocardiography

We sought to prospectively evaluate the clinical application of the American College of Cardiology Foundation/American Society of Echocardiography Appropriateness Criteria (AC) for transthoracic echocardiography in a single-center university hospital. Indications for transthoracic echocardiograms (T...

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Bibliographic Details
Published in:JACC. Cardiovascular imaging 2008-09, Vol.1 (5), p.663-671
Main Authors: Ward, R. Parker, MD, FACC, Mansour, Ibrahim N., MD, Lemieux, Nicole, MD, Gera, Nitin, MD, Mehta, Rupa, MD, Lang, Roberto M., MD, FACC
Format: Article
Language:English
Subjects:
Adult
Aged
Cardiovascular
Echocardiography - standards
Echocardiography - utilization
Feasibility Studies
Female
Guideline Adherence
Heart Diseases - diagnostic imaging
Hospitals, University - standards
Humans
Illinois
Male
Middle Aged
Patient Selection
Practice Guidelines as Topic
Practice Patterns, Physicians' - standards
Prospective Studies
Quality of Health Care - standards
Referral and Consultation - standards
Societies, Medical
Unnecessary Procedures
Utilization Review
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Summary:We sought to prospectively evaluate the clinical application of the American College of Cardiology Foundation/American Society of Echocardiography Appropriateness Criteria (AC) for transthoracic echocardiography in a single-center university hospital. Indications for transthoracic echocardiograms (TTE) were prospectively determined for consecutive studies by 2 reviewers and categorized, according to the AC for TTE, as appropriate (A) or inappropriate (I). The overall level of agreement in characterizing appropriateness between reviewers was high (kappa = 0.83). Among the 1,553 studies for which a primary indication was determined, 89% were covered in the AC for TTE. Of these studies, 89% were A, and 11% were I. New important TTE abnormalities were more common on A compared with I studies (40% vs. 17%, p < 0.001), and noncardiac specialists more frequently ordered I studies (13% vs. 9%, p = 0.04). In conclusion, the AC for TTE encompasses the majority of clinical indications for TTE and appears to reasonably stratify TTE ordering. However, revisions will be needed to fully capture and stratify appropriate clinical practice.
ISSN:1936-878X
1876-7591
DOI:10.1016/j.jcmg.2008.07.004