title: Assessment of inpatient multimodal cardiac imaging appropriateness at large academic medical centers.
abstract: BACKGROUND
  Responding to concerns regarding the growth of cardiac testing, the American College of Cardiology Foundation (ACCF) published Appropriate Use Criteria (AUC) for various cardiac imaging modalities. Single modality cardiac imaging appropriateness has been reported but there have been no studies assessing the appropriateness of multiple imaging modalities in an inpatient environment.
  
  
  METHODS
  A retrospective study of the appropriateness of cardiac tests ordered by the inpatient General Internal Medicine (GIM) and Cardiology services at three Canadian academic hospitals was conducted over two one-month periods. Cardiac tests characterized were transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), single-photon emission tomography myocardial perfusion imaging (SPECT), and diagnostic cardiac catheterization.
  
  
  RESULTS
  Overall, 553 tests were assessed, of which 99.8% were classifiable by AUC. 91% of all studies were categorized as appropriate, 4% may be appropriate and 5% were rarely appropriate. There were high rates of appropriate use of all modalities by GIM and Cardiology throughout. Significantly more appropriate diagnostic catheterizations were ordered by Cardiology than GIM (93% vs. 82%, p = <0.01). Cardiology ordered more appropriate studies overall (94% vs. 88%, p = 0.03) but there was no difference in the rate of rarely appropriate studies (3% vs. 6%, p = 0.23).
  
  
  CONCLUSIONS
  The ACCF AUC captured the vast majority of clinical scenarios for multiple cardiac imaging modalities in this multi-centered study on Cardiology and GIM inpatients in the acute care setting. The rate of appropriate ordering was high across all imaging modalities. We recommend further work towards improving appropriate utilization of cardiac imaging resources focus on the out-patient setting.
authors.affiliation: University of Toronto Medical School, Medical Sciences Building, 1 King's College Circle, Toronto, M5S 1A8, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Remfry
authors.affiliation: University of Toronto Medical School, Medical Sciences Building, 1 King's College Circle, Toronto, M5S 1A8, Canada.|Peter Munk Cardiac Centre of the University Health Network, Toronto General Hospital, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada.
authors.forename: Howard
authors.initials: H
authors.lastname: Abrams
authors.affiliation: Massachusetts General Hospital, 55 Fruit Sreet, Boston, MA, 02114, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Dudzinski
authors.affiliation: Massachusetts General Hospital, 55 Fruit Sreet, Boston, MA, 02114, USA.
authors.forename: Rory B
authors.initials: RB
authors.lastname: Weiner
authors.affiliation: University of Toronto Medical School, Medical Sciences Building, 1 King's College Circle, Toronto, M5S 1A8, Canada. sacha.r.bhatia@wchospital.ca.|Peter Munk Cardiac Centre of the University Health Network, Toronto General Hospital, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada. sacha.r.bhatia@wchospital.ca.|Women's College Hospital Institute for Health Systems Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada. sacha.r.bhatia@wchospital.ca.|Adjunct Scientist, Institute for Clinical Evaluative Sciences, Division of Cardiology, University Health Network and Women's College Hospital, University of Toronto, 76 Grenville Street, 6th Floor, Toronto, ON, M5S 1B2, Canada. sacha.r.bhatia@wchospital.ca.
authors.forename: R Sacha
authors.initials: RS
authors.lastname: Bhatia
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D002170:Canada / Q000453:epidemiology; D057791:Cardiac Imaging Techniques / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D000069342:Medical Overuse / Q000706:statistics & numerical data*; D064847:Multimodal Imaging / Q000706:statistics & numerical data*; D014600:Utilization Review