Gibbons Raymond J, Carryer Damita, Liu Hongfang, Brady Peter A, Askew J Wells, Hodge David, Ammash Naser, Ebbert Jon O, Roger Veronique L
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2015 Nov;90(11):1492-8. doi: 10.1016/j.mayocp.2015.07.025. Epub 2015 Oct 10.
To determine how often unnecessary resting echocardiograms that are "not recommended" by clinical practice guidelines are performed in patients with stable chest pain and normal resting electrocardiograms (ECGs).
We performed a retrospective search of electronic medical records of all outpatients seen at Mayo Clinic Rochester from January 1, 2010, through December 31, 2013, to identify residents of Olmsted County, Minnesota, with stable chest pain and known or suspected coronary artery disease who underwent resting echocardiography and had normal resting ECGs and no other indication for echocardiography.
Of the 8280 outpatients from Olmsted County who were evaluated at Mayo Clinic Rochester with chest pain, 590 (7.1%) had resting echocardiograms. Ninety-two of these 590 patients (15.6%) had normal resting ECGs. Thirty-three of these 92 patients (35.9%) had other indications for echocardiography. The remaining 59 patients (10.0% of all echocardiograms and 0.7% of all patients) had normal resting ECGs and no other indication for echocardiography. Fifty-seven of these 59 patients (96.6%) had normal echocardiograms. Thirteen of these 59 echocardiograms (22.0%) were "preordered" before the provider (physicians, nurses, physician assistants) visit.
The overall rate of echocardiography in Olmsted County outpatients with chest pain seen at Mayo Clinic Rochester is low. Only 1 in 10 of these echocardiograms was performed in violation of the class III recommendation in the American College of Cardiology Foundation/American Heart Association guidelines for the management of stable angina. These unnecessary echocardiograms were almost always normal. The rate of unnecessary echocardiograms could be decreased by eliminating preordering.
确定在临床实践指南“不推荐”的情况下，稳定型胸痛且静息心电图（ECG）正常的患者接受不必要的静息超声心动图检查的频率。
我们对2010年1月1日至2013年12月31日在梅奥诊所罗切斯特分院就诊的所有门诊患者的电子病历进行了回顾性检索，以识别明尼苏达州奥尔姆斯特德县患有稳定型胸痛且已知或疑似冠心病的居民，这些患者接受了静息超声心动图检查，静息ECG正常且无其他超声心动图检查指征。
在梅奥诊所罗切斯特分院接受胸痛评估的8280名奥尔姆斯特德县门诊患者中，590人（7.1%）接受了静息超声心动图检查。这590名患者中有92人（15.6%）静息ECG正常。这92名患者中有33人（35.9%）有其他超声心动图检查指征。其余59名患者（占所有超声心动图检查的10.0%，占所有患者的0.7%）静息ECG正常且无其他超声心动图检查指征。这59名患者中有57人（96.6%）超声心动图检查正常。这59次超声心动图检查中有13次（22.0%）是在医疗服务提供者（医生、护士、医师助理）就诊前“预开单”的。
在梅奥诊所罗切斯特分院就诊的奥尔姆斯特德县胸痛门诊患者中，超声心动图检查的总体比例较低。这些超声心动图检查中只有十分之一是违反美国心脏病学会基金会/美国心脏协会稳定型心绞痛管理指南III类推荐进行的。这些不必要的超声心动图检查几乎总是正常的。通过取消预开单可以降低不必要超声心动图检查的比例。
