title: [The evaluation of the appropriateness of instrumental exams in cardiology. The case of echocardiography].
abstract: BACKGROUND
  The aim of this study was to evaluate the appropriateness and utility rates of echocardiograms performed in 309 patients in an outpatient clinical setting.
  
  
  METHODS
  Data were collected by means of a questionnaire filled in by the cardiologists who performed the examinations. Appropriateness was evaluated according to international guidelines and scored as class I: appropriate, class II: doubtful appropriateness, class III: inappropriate; the exam was deemed useful if it was able to influence the clinical decision-making; normalcy rate was also checked. The relationship between both the referring physicians and motivation of the exam and its appropriateness, and the relationship between appropriateness and both the normalcy rate and utility of the exam were assessed.
  
  
  RESULTS
  An echocardiogram was requested by the cardiologist in 46% of patients; the more common reasons for the exam were arterial hypertension (26%), cardiac murmur (18%), palpitations (15%), and known coronary artery disease (10%). The echocardiogram was appropriate (class I) in 25% of patients, doubtfully appropriate (class II) in 39% of patients and inappropriate (class III) in 36% of patients. The appropriateness rate between the cardiologists was similar to that of other prescribing clinicians (p = NS). The highest class III rate was found in patients with hypertension, while the highest class I rate was found in patients with a cardiac murmur (p < 0.01). Normalcy rate was lower in class I than in class II and III exams (p < 0.001). The utility rate was higher in class I (76%) than in class II (13%) and III (< 1%) exams (p < 0.01).
  
  
  CONCLUSIONS
  International guidelines can be used effectively and safely to identify (not to prescribe) the useless echocardiograms.
authors.affiliation: Unità Operativa di Malattie Cardiovascolari, Ospedale Campo di Marte, Lucca. lorenzoni.r@lunet.it
authors.forename: R
authors.initials: R
authors.lastname: Lorenzoni
authors.forename: M
authors.initials: M
authors.lastname: Magnani
authors.forename: A
authors.initials: A
authors.lastname: Accardo
authors.forename: G
authors.initials: G
authors.lastname: Mazzotta
authors.forename: A
authors.initials: A
authors.lastname: Azzarelli
authors.forename: A
authors.initials: A
authors.lastname: Boni
authors.forename: L
authors.initials: L
authors.lastname: Cortigiani
authors.forename: P
authors.initials: P
authors.lastname: Del Giallo
authors.forename: A
authors.initials: A
authors.lastname: Frugoli
authors.forename: M
authors.initials: M
authors.lastname: Lazzari
authors.forename: M
authors.initials: M
authors.lastname: Masini
authors.forename: L
authors.initials: L
authors.lastname: Odoguardi
authors.forename: L
authors.initials: L
authors.lastname: Piombino
authors.forename: M
authors.initials: M
authors.lastname: Pogliani
authors.forename: L
authors.initials: L
authors.lastname: Zanetti
authors.forename: E
authors.initials: E
authors.lastname: Nannini
mesh_terms: D016009:Chi-Square Distribution; D003365:Costs and Cost Analysis; D004452:Echocardiography / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D011795:Surveys and Questionnaires; D014600:Utilization Review / Q000379:methods*