title: [Appropriateness of prescription of exercise stress test, echocardiography, Holter monitoring and vascular echography].
abstract: BACKGROUND
  The aim of this study was to evaluate the appropriateness of prescription of non-invasive cardiological tests (exercise stress test, echocardiography, Holter monitoring and vascular echography), consecutively performed in our outpatient laboratory during 4 weeks.
  
  
  METHODS
  We collected the following data: the appropriateness of prescription (according to the Italian Federation of Cardiology guidelines); test indications; the prescribing physician (cardiologist/non-cardiologist); type of prescription (elective/urgent); clinical utility (useful/useless) and result (normal/abnormal) of each test.
  
  
  RESULTS
  We evaluated 960 prescriptions (320 exercise tests; 282 echocardiograms; 158 Holter tests; 200 vascular echographies). Test indications were appropriate (class I) in 37%, doubtfully appropriate (class II) in 39% and inappropriate (class III) in 24% of the cases. The appropriateness was slightly better for vascular echography and echocardiography (class I: 44% and 43%, respectively), markedly worse for exercise test (class I: 27%). The tests were considered useful in 46% and abnormal in 39% of the cases. Cardiologist-prescribed exams resulted more often appropriate (class I: 53 vs 30%; class II: 41 vs 38%; class III: 6 vs. 32%; p = 0.0001), more often useful (74 vs. 34%; p = 0.0001) and more frequently abnormal (43 vs. 37%; p = 0.05), when compared to non-cardiologist-prescribed exams. No differences in appropriateness, utility and test result have been detected between elective and urgent exams. Exercise test, echocardiogram and Holter monitoring resulted more often appropriate and useful when prescribed by cardiologists.
  
  
  CONCLUSIONS
  This study confirms that only one third of prescriptions for non-invasive cardiological tests are appropriate. Cardiologist-prescribed exams are more often appropriate, useful and abnormal.
authors.affiliation: U.O. di Malattie Cardiovascolari, ASL 5 di Pisa, Ospedale F. Lotti, Pontedera, PI. enrico.orsini@alice.it
authors.forename: Enrico
authors.initials: E
authors.lastname: Orsini
authors.forename: Roberto
authors.initials: R
authors.lastname: Lorenzoni
authors.forename: Francesco
authors.initials: F
authors.lastname: Becherini
authors.forename: Stefano
authors.initials: S
authors.lastname: Giaconi
authors.forename: Daniele
authors.initials: D
authors.lastname: Levantesi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Lucarini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Paterni
authors.forename: Barbara
authors.initials: B
authors.lastname: Reisenhofer
authors.forename: Alberto
authors.initials: A
authors.lastname: Topi
authors.forename: Stefano
authors.initials: S
authors.lastname: Viani
authors.forename: Caterina
authors.initials: C
authors.lastname: Violo
authors.forename: Cristina
authors.initials: C
authors.lastname: Zecchi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tartarini
mesh_terms: D004452:Echocardiography / Q000592:standards / Q000706:statistics & numerical data*; D015716:Electrocardiography, Ambulatory / Q000592:standards / Q000706:statistics & numerical data*; D005080:Exercise Test / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D011237:Predictive Value of Tests; D012107:Research Design; D018084:Ultrasonography, Interventional / Q000592:standards / Q000706:statistics & numerical data*