Department of Cardiology, Regional Cardiac Centre Morriston, Morriston Hospital, Swansea, UK.
Eur Heart J Cardiovasc Imaging. 2014 Apr;15(4):450-5. doi: 10.1093/ehjci/jet186. Epub 2013 Oct 22.
Appropriateness of use criteria (AUC) for transthoracic echocardiography (TTE) have been developed by American cardiology associations to help avoid unnecessary scans by formalizing indications for imaging. There are 98 indications classified as either appropriate (A), inappropriate (I), or uncertain (U). AUC may allow better targeting of limited resources, but they have not been tested systematically outside the USA.
To test AUC in Wales, one of the four countries of the UK.
We collected requests for TTE and the corresponding TTE reports from all Welsh hospitals during 1 week in June 2012 and analysed them according to appropriateness, specialty, and location (secondary vs. tertiary services) of the referring physician.
We analysed 1070 pairs of echocardiography requests and TTE reports from 14 hospitals [mean age 66.5 (16.1) years; 579 (51%) M]: A-922 (86%); I-115 (11%), and U-33 (3%); 287 (25%) studies were from two tertiary centres and 338 (29.5%) were of inpatients. Main indications were the evaluation of: cardiac structure and function (489, 45.7%), valvular function (267, 25%), and hypertension, heart failure, or cardiomyopathy (149, 13.9%). In-patient requests (main indication--'initial evaluation of left ventricle ejection fraction post acute coronary syndrome'--44 studies, 13.7%) were more often appropriate than outpatients (main indication--'symptoms/conditions potentially related to suspected cardiac aetiology'--142 studies, 19.8%): 94.4 vs. 83.5%, P < 0.05. The most common inappropriate indication was 'initial evaluation for a murmur/click without symptoms/signs of structural heart disease' (29 studies, 2.7%). The proportion of appropriate requests by specialty was 89% for medical, 87% for GPs, 85.3% for cardiologists, 80.8% for surgical, and 60% for cardiac surgeons (P < 0.05 for cardiac surgeons); 47.8% of requests were generated by cardiologists, and abnormalities were detected in 82% of all scans (37% minor findings and 45% major findings), least often in those requested by general practitioners.
Application of AUC yields results similar to those reported from the USA; ∼1 in 10 scans could be avoided.
美国心脏病学会制定了经胸超声心动图（TTE）的适宜性使用标准（AUC），以通过正式确定影像学指征来帮助避免不必要的扫描。有 98 种适应证分为适宜（A）、不适宜（I）或不确定（U）。AUC 可能允许更好地针对有限的资源，但它们尚未在美国以外的系统中进行测试。
在英国的四个国家之一威尔士测试 AUC。
我们收集了 2012 年 6 月一周内威尔士所有医院的 TTE 请求和相应的 TTE 报告，并根据适应证、专业和转诊医生的位置（二级与三级服务）进行分析。
我们分析了来自 14 家医院的 1070 对超声心动图请求和 TTE 报告[平均年龄 66.5（16.1）岁；579 名男性（51%）]：A 级 922 例（86%）；I 级 115 例（11%）和 U 级 33 例（3%）；287 例（25%）研究来自两个三级中心，338 例（29.5%）为住院患者。主要适应证为：心脏结构和功能评估（489 例，45.7%）、瓣膜功能评估（267 例，25%）和高血压、心力衰竭或心肌病评估（149 例，13.9%）。住院患者的请求（主要适应证——“急性冠状动脉综合征后左心室射血分数的初始评估”——44 例，13.7%）比门诊患者更适宜（主要适应证——“可能与疑似心脏病因相关的症状/情况”——142 例，19.8%）：94.4% 比 83.5%，P<0.05。最常见的不适宜适应证是“无结构性心脏病症状/体征的初始评估杂音/喀喇音”（29 例，2.7%）。按专业划分，适宜请求的比例为内科 89%、全科医生 87%、心脏病专家 85.3%、外科 80.8%和心脏外科医生 60%（心脏外科医生之间存在差异，P<0.05）；47.8%的请求由心脏病专家发起，82%的所有扫描发现异常（37%为轻微发现，45%为主要发现），最不常见的是由全科医生发起。
应用 AUC 的结果与美国报道的结果相似；大约每 10 次扫描中就有 1 次可以避免。
