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Indications, Utility and Appropriateness of Echocardiography in Outpatient Cardiology
, Enrico Orsini1, Ettore Antoncecchi2
1Cardiac, Thoracic and Vascular Department, University of Pisa, Italy.
Insights
Echocardiogram appropriateness is suboptimal, particularly when prescribed by non-cardiologists. Cardiologists should lead patient care to improve test utility and pertinence in cardiology practice.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Appropriateness of diagnostic tests is crucial for clinical and economic efficiency, and managing waiting lists.
- Few studies have assessed appropriateness in clinical practice, with most focusing on hospital admissions and invasive procedures.
Purpose of the Study:
- To evaluate the indications, utility, and appropriateness of echocardiography in outpatient cardiology.
- To assess the impact of the prescribing physician on echocardiogram appropriateness.
Main Methods:
- Prospective, multicenter study (INDICARD-out) involving cardiologists from 13 Italian Regions.
- Evaluation of 2110 echocardiogram prescriptions for indications, utility, and appropriateness.
Main Results:
- Hypertension and asymptomatic screening were the most common indications for echocardiography.
- Overall, 54% of echocardiograms were appropriate, 30% uncertain, and 16% inappropriate.
- Prescriptions from non-cardiologists (72%) resulted in significantly less appropriate, useful, and pertinent tests compared to those from cardiologists.
Conclusions:
- Echocardiogram appropriateness, utility, and pertinence remain suboptimal in clinical practice, especially when prescribed by non-cardiologists.
- Cardiologists should transition from test executors to primary clinicians managing all cardiologic patient needs.
Objective:
Respect of "appropriateness" is considered an essential requirement, both on the clinical and the economic profile, and also as it helps to shorten the waiting list. However, only a few studies have dealt with the control of appropriateness in clinical practice, and most of them have focused only on hospital admissions and invasive procedures.
Materials And Methods:
INDICARD-out is a prospective, multicenter study carried out by A.R.C.A. (Associazioni Regionali Cardiologi Ambulatoriali) cardiologists from 13 Italian Regions, providing information on indications, utility and appropriateness of echocardiography in outpatient cardiology.
Results:
A total of 2110 prescriptions for echocardiogram were evaluated. Hypertension (23%) and the screening of asymptomatic subjects (17%) by far were the most frequent indications to echocardiography. Overall, 54% of the tests resulted appropriate, 30% were of uncertain appropriateness and 16% were inappropriate. Besides, 31% of the echocardiograms were not useful, and 28% were non pertinent for patient management. The vast majority of prescriptions (72%) came from non-cardiologist physicians (54% from general practitioners). The echocardiograms prescribed by cardiologists were significantly more appropriate, more useful and more pertinent than the tests prescribed by non-cardiologists.
Conclusions:
The appropriateness, utility and pertinence of the echocardiography are still suboptimal in practice cardiology, especially when indicated by non-cardiologists. The cardiologist, from mere executor of tests prescribed and managed by other physicians, should gain the role of the clinician who takes care of all the cardiologic needs of the patient community.
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