[Appropriateness of prescription of exercise stress test, echocardiography, Holter monitoring and vascular echography].
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.
Orsini
Enrico
E
U.O. di Malattie Cardiovascolari, ASL 5 di Pisa, Ospedale F. Lotti, Pontedera, PI. enrico.orsini@alice.it
Lorenzoni
Roberto
R
Becherini
Francesco
F
Giaconi
Stefano
S
Levantesi
Daniele
D
Lucarini
Alessandra
A
Paterni
Giovanni
G
Reisenhofer
Barbara
B
Topi
Alberto
A
Viani
Stefano
S
Violo
Caterina
C
Zecchi
Cristina
C
Tartarini
Giuseppe
G
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*