Updated AUC improved clinical application of stress echocardiography

Updated 2011 appropriate use criteria for referring stress echocardiographs improved clinical application by encompassing nearly all indications, but the number of inappropriate indications were unchanged, according to data from one institution published in JACC: Cardiovascular Imaging.

Researchers conducted a retrospective survey using electronic medical records from the University of Miami Health System over three different time periods in 2008 and 2011. In the first cohort, 209 patients underwent stress echocardiography between August and September 2008 using original and updated appropriate use criteria (AUC). The second cohort involved 209 patients referred for stress echocardiography between July and September 2011, 4 months after revised AUC were published, and this group was compared with the 2008 cohort. The third cohort had 111 patients referred for stress echocardiography by cardiologists between the third week of October and the final week of December 2011, 2 weeks after an educational initiative.

Howard J. Willens

Of the 529 referred stress echocardiographs, 43.5% were requested for appropriate indications, 22.9% were requested for uncertain conditions and 30.8% for inappropriate indications, according to 2011 AUC recommendations.

According to results, based on the 2011 AUC, original ratings of 25% of studies by AUC 2008 changed and the number of unclassified stress echocardiographs decreased from 9.6% to 1%.

The correlation between radiology benefits managers’ precertification guidelines and AUC ratings was substantial for the first radiology benefits managers and fair for the second, researchers found. In addition, 12.9% of stress echocardiographs considered appropriate or uncertain would not have received preauthorization according to the guidelines of the first radiology benefits managers, and 41.9% of stress echocardiographs considered appropriate or uncertain would not have received preauthorization according to guidelines of the second radiology benefits managers.

“We observed that [stress echocardiography] was often requested for inappropriate indications according to both sets of AUC,” Howard J. Willens, MD, of the department of medicine, division of cardiology, University of Miami Miller School of Medicine, and researchers wrote. “Additionally, we report that the number of [stress echocardiographs] requested for inappropriate indications did not change over time despite enhanced recognition of AUC. Unfortunately, the education initiative directed toward cardiologists also did not result in a reduction in the number of [stress echocardiographs] requested for inappropriate indications.”

For more information:

Willens HJ. J Am Coll Cardiol Img. 2013;doi:10.1016/j.jcmg.2012.11.009.

Disclosure: The researchers report no relevant financial disclosures.