[Evaluation of the appropriateness of prescribing non-invasive cardiologic tests].
BACKGROUND
We evaluated the appropriateness of the prescription of echocardiography, exercise testing, Holter monitoring and vascular sonography for ambulatory patients, performed during 4 weeks in 21 outpatient laboratories in Tuscany and Umbria, Italy.


METHODS
We collected the following data: the appropriateness of the prescription (according to the guidelines of the Italian Federation of Cardiology), the prescribing physician (cardiologist vs noncardiologist), the synthetic result (normal vs abnormal) and the clinical utility (useful vs useless) of each exam.


RESULTS
We evaluated 5614 prescriptions (patients: 3027 males, 2587 females; mean age 63 years, range 14-96 years). The indication to the test was of class I (appropriate) in 45.3%, of class II (doubtfully appropriate) in 34.8% and of class III (inappropriate) in 19.9% of the cases. The test was abnormal in 58.3% of class I exams vs 17% of class III exams (p < 0.05). The test was useful in 72.4% of class I exams vs 17.1% of class III exams (p < 0.05). The test was prescribed by a cardiologist in 1882 cases (33.5%). Cardiologist-prescribed exams were of class I in 57.3%, of class II in 32.4% and of class III in 10.3% of the cases vs 39.2, 36.1 and 24.7% of non-cardiologist-prescribed exams (p < 0.05). Cardiologist-prescribed exams were abnormal in 53.4% of the cases vs 39% of those of non-cardiologists' (odds ratio 1.76, 95% confidence interval 1.58-1.97; p < 0.05). Cardiologist-prescribed exams were useful in 64.7% of the cases vs 44.4% of those of non-cardiologists' (odds ratio 2.26, 95% confidence interval 2.02-2.53; p < 0.05).


CONCLUSIONS
In Tuscany and Umbria, Italy, less than half of the prescriptions for non-invasive diagnostic tests are appropriate: appropriately prescribed exams more often provide abnormal and useful results; cardiologist-prescribed exams are more often appropriate, abnormal and useful.
Lorenzoni
Roberto
R
U.O. di Malattie Cardiovascolari Ospedale Campo di Marte 55100 Lucca. lorenzoni.r@tin.it
Baldini
Paolo
P
Bernardi
Daniele
D
Bonatti
Vincenzo
V
Dabizzi
Roberto
R
Del Citerna
Federico
F
De Tommasi
Mario
M
Galli
Michele
M
Giannini
Raffaella
R
Macrì
Rocco
R
Mandorla
Sara
S
Mazzoni
Vincenzo
V
Micheli
Giovanni
G
Nannini
Eugenio
E
Pesola
Antonio
A
Severi
Silva
S
Tartarini
Giuseppe
G
Tonelli
Luigi
L
Vergoni
William
W
Vergassola
Rossano
R
Zuppiroli
Alfredo
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000592:standards; D002309:Cardiology / Q000592:standards* / Q000706:statistics & numerical data; D003935:Diagnostic Techniques, Cardiovascular / Q000592:standards* / Q000706:statistics & numerical data*; D004452:Echocardiography / Q000592:standards / Q000706:statistics & numerical data; D015716:Electrocardiography, Ambulatory / Q000592:standards / Q000706:statistics & numerical data; D005069:Evaluation Studies as Topic; D005080:Exercise Test / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008511:Medicine / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D013038:Specialization; D014600:Utilization Review