P255Are we using Dobutamine stress echo appropriately? A survey of conformity to appropriateness criteria in a tertiary centre

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Background: Avoidance of un-necessary medical investigations is an essential component of effective cost-management in a strained financial milieu. Recently, professional societies in cardiology have devised appropriateness criteria for the performance of stress echocardiography. Setting. Cardiac tertiary centre serving a population of 1 million and performing 500 Dobutamine stress echocardiograms (DSE) / year.Aim: To assess whether DSEs in our centre are requested for appropriate indications.Methods: We used the American Heart Association (AHA) appropriateness criteria for DSE, which rank the indications for DSE as highly appropriate (appropriateness score A 7-8), uncertain (A 4-6) and inappropriate (A 1-3), to categorise a random sample of referrals for DSE over a period of 6 months in 2010.Results: We selected 45 requests and excluded 8 which did not contain enough information to calculate the appropriateness score. There were 19 males and 18 females, age range 33-85 years, mean (SD) 63.3 (11.9) years, with 33 (89%) appropriate requests (A8 – 24 requests; A7 – 9 requests). The leading appropriate request reasons were: assessment of chest pain after coronary revascularisation (11 patients, 28%), evaluation of chest pain in patients who were unable to exercise or in whom exercise ECG was equivocal (11 pts, 26%), and re-evaluation of patients treated medically (6 pts, 15%). There were 2 (5%) requests for inappropriate indications (in low-risk patients who were able to exercise) and 1 (3%) request of uncertain appropriateness (DSE for the assessment of transmitral gradient in mitral stenosis).Conclusions: In our practice, requests for DSE are overwhelmingly made for appropriate reasons, and ‘managing demand’ for this service is unlikely to produce major cost savings.

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