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Appropriate use of echocardiography and relation to clinical decision making in both inpatients and outpatients in a developing country
Author(s) -
Romano Minna Moreira Dias,
Branco Marina,
Moreira Henrique Turin,
Schmidt André,
Kisslo Joseph,
Maciel Benedito Carlos
Publication year - 2018
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13725
Subject(s) - medicine , appropriate use criteria , clinical decision making , intensive care medicine
Background Use of echocardiography (echo) has exponentially increased in recent decades. Concerned about this scientific society developed appropriate use criteria ( AUC ). Clinical management still suffers geographical variations, and no objective data are available about echo AUC in developing countries. We aimed to evaluate (1) the appropriateness of referrals and (2) their relation to changes in clinical decision management. Methods Prospective analysis of referrals from January to December 2014. Appropriateness and endpoints analyzed in different time points from medical archives. Endpoints: (1) change in the diagnosis, (2) indication for another method to complete the diagnosis, (3) change in clinical treatment, (4) indication for a treatment intervention, or (5) no change in management. Descriptive statistical analysis, Fisher's or chi‐square tests, and Cox regression used as appropriate (significance if P < .05). Results One thousand one hundred referrals were analyzed (55.5 ± 16.1 years, 44.6% male). 80.5% of referrals were appropriate (A), 11.2% “Rarely Appropriate” ( RA ), and 8.3% “May Be Appropriate” ( MBA ). Proportion of (A) did not differ between modalities ( TTE ‐80.5% vs TEE ‐87.7% vs STR ‐81.2%, P = .67). (A) referrals were more related to clinical decision than ( RA )+( MBA ) (38.9% [A] vs 15% [ RA ]+[ MBA ], P < .001). The most frequent clinical indications of ( RA ) and ( MBA ) TTE were reevaluation of ventricular function without clinical change ( AUC 10 and 11) and search of infectious endocarditis when low clinical probability (53). Conclusions In a developing country, appropriateness of echo was similar to the United States and Europe. However, a significant proportion of referrals were still ( RA ) or ( MBA ), with no effect in clinical management. Controlling referrals 10, 11, and 53 can optimize echo use in developing countries.