Thomas Jefferson University, Philadelphia, Pennsylvania.
J Am Soc Echocardiogr. 2014 Jan;27(1):1-7. doi: 10.1016/j.echo.2013.08.027. Epub 2013 Oct 2.
Cardiac imaging is under intense scrutiny as a contributor to health care costs, with multiple initiatives under way to reduce and eliminate inappropriate testing. Appropriate use criteria are valuable guides to selecting imaging studies but until recently have focused on the test rather than the patient. Patient-centered means are needed to define the true value of imaging for patients in specific clinical situations. This article provides a definition of high-value cardiac imaging. A paradigm to judge the efficacy of echocardiography in the absence of randomized controlled trials is presented. Candidate clinical scenarios are proposed in which echocardiography constitutes high-value imaging, as well as stratagems to increase the likelihood that high-value cardiac imaging takes place in those circumstances.
心脏影像学检查在医疗费用方面受到了广泛关注，目前已经采取了多项措施来减少和消除不必要的检查。适宜性使用标准是选择影像学检查的有价值的指南，但直到最近才关注到检查本身，而不是患者。需要以患者为中心的方法来确定影像学检查在特定临床情况下对患者的真正价值。本文提供了高价值心脏影像学的定义。在缺乏随机对照试验的情况下，提出了一种用于评判超声心动图疗效的范例。本文还提出了一些可能的临床情况，在这些情况下，超声心动图构成了高价值的影像学检查，并提出了一些策略来增加在这些情况下进行高价值心脏影像学检查的可能性。
