[Evaluation of the appropriateness of prescribing exercise tests].
BACKGROUND
We evaluated the appropriateness of the indications to exercise testing for ambulatory patients performed during 4 weeks in 21 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 non-cardiologist), the synthetic result (normal vs abnormal) and the clinical utility (useful vs useless) of each exam.


RESULTS
We evaluated 1158 prescriptions (population: 822 males, 336 females; mean age 60 years, range 16-82 years). Prescriptions were of class I (appropriate) in 38.9%, of class II (of doubtful appropriateness) in 52.5% and of class III (inappropriate) in 8.6% of the cases. In 14.2% of the cases the exam was abnormal: it was abnormal in 35.5% of class I, in 26.6% of class II and in 23% of class III exams (p < 0.05). The exam was useful in 51.6% of the cases; it was useful in 62.4% of class I, in 50.2% of class II and in 13% of class III exams (p < 0.05). Cardiologists required 596/1158 tests (51.5%). Their indications were included in class I in 45.6%, in class II in 49.7% and in class III in 4.7% of the cases vs 31.7, 55.5 e 12.8% of non-cardiologists' prescriptions (p < 0.05). The test was abnormal in 35.7% of cardiologist vs 23.5% of non-cardiologist-prescribed examinations (odds ratio 1.81, 95% confidence interval 1.4-2.34; p < 0.05); the test was useful in 64.4% of cardiologist vs 38.2% of non-cardiologist-prescribed exams (odds ratio 2.92, 95% confidence interval 2.3-3.71; p < 0.05).


CONCLUSIONS
In Tuscany and Umbria, Italy, less than half of exercise testing procedures are appropriate; appropriately-prescribed exams are more often abnormal and useful; cardiologist-prescribed exams are significantly more appropriate, abnormal and useful.
U.O. di Malattie Cardiovascolari ASL 5 di Pisa Zona Valdera Ospedale F. Lotti Via Roma, 180, 56125 Pontedera, PI. enrico.orsini@tiscalinet.it
Enrico
E
Orsini
Francesco
F
Mazzuoli
Leonardo
L
Odoguardi
Mirco
M
Magnani
Roberto
R
Lorenzoni
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000592:standards; D002309:Cardiology / 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