P883How the publication of stress echo apropriatness criteria has affected the clinical application of stress echo studies in a tertiatry academic center.


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Abstract

Purpose: The criteria for appropriate use of stress echocardiography were published for the first time in 2007. The aim of this study was to evaluate how the publication of these criteria has affected the clinical application of stress echocardiography in a tertiary academic center.Methods: We retrospectively evaluated 7995 patients (pts) with known or suspected coronary artery disease (CAD) who underwent dobutamine stress echocardiography over a 4-year period (2005-2010). The pts were divided in two groups: the first group included 3.950 pts who underwent stress echo before and the second group included 4045 pts who underwent stress echo after the publication of appropriatness criteria. Each patient was classified as Appropriate, Uncertain or Inappropriate for stress echocardiography.Results: The mean age of the first group was 61.4 ±4.7 (65% men) whereas of the second was 68.2±3.9 years old (62% men). In the first group, 42% were classified as appropriate, 36% as uncertain and 22% as inappropriate. Among the pts classified as inappropriate, 61% were asymptomatic individuals who had recently undergone successful revascularization. The application of appropriateness criteria led to an increase of appropriate studies from 42% to 64% (p<0.05), while uncertain studies decreased from 36% to 25% (p=NS) and inappropriate studies from 22% to 11% (p<0.05). Again most inappropriate studies in the second group (45%) referred to asymptomatic pts after recent successful revascularization, a proportion not statistically different as compared to the first group (respective rate was 61%).Conclusion: While after the publication of appropriateness criteria the overall rate of inappropriate stress echo studies has been reduced, the rate of inappropriate stress echo studies for asymptomatic pts with recent successful revascularization has not. These findings emphasize the importance of adhering to the criteria in order to render the test cost-effective.

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