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Appropriate use of echocardiography and relation to clinical decision making in both inpatients and outpatients in a developing country.

Publication ,  Journal Article
Romano, MMD; Branco, M; Moreira, HT; Schmidt, A; Kisslo, J; Maciel, BC
Published in: Echocardiography
January 2018

BACKGROUND: Use of echocardiography (echo) has exponentially increased in recent decades. Concerned about this scientific society developed appropriate use criteria (AUC). Clinical management still suffers geographical variations, and no objective data are available about echo AUC in developing countries. We aimed to evaluate (1) the appropriateness of referrals and (2) their relation to changes in clinical decision management. METHODS: Prospective analysis of referrals from January to December 2014. Appropriateness and endpoints analyzed in different time points from medical archives. ENDPOINTS: (1) change in the diagnosis, (2) indication for another method to complete the diagnosis, (3) change in clinical treatment, (4) indication for a treatment intervention, or (5) no change in management. Descriptive statistical analysis, Fisher's or chi-square tests, and Cox regression used as appropriate (significance if P < .05). RESULTS: One thousand one hundred referrals were analyzed (55.5 ± 16.1 years, 44.6% male). 80.5% of referrals were appropriate (A), 11.2% "Rarely Appropriate" (RA), and 8.3% "May Be Appropriate" (MBA). Proportion of (A) did not differ between modalities (TTE-80.5% vs TEE-87.7% vs STR-81.2%, P = .67). (A) referrals were more related to clinical decision than (RA)+(MBA) (38.9% [A] vs 15% [RA]+[MBA], P < .001). The most frequent clinical indications of (RA) and (MBA) TTE were reevaluation of ventricular function without clinical change (AUC 10 and 11) and search of infectious endocarditis when low clinical probability (53). CONCLUSIONS: In a developing country, appropriateness of echo was similar to the United States and Europe. However, a significant proportion of referrals were still (RA) or (MBA), with no effect in clinical management. Controlling referrals 10, 11, and 53 can optimize echo use in developing countries.

Duke Scholars

Published In

Echocardiography

DOI

EISSN

1540-8175

Publication Date

January 2018

Volume

35

Issue

1

Start / End Page

9 / 16

Location

United States

Related Subject Headings

  • Referral and Consultation
  • Prospective Studies
  • Practice Patterns, Physicians'
  • Outpatients
  • Middle Aged
  • Male
  • Inpatients
  • Humans
  • Guideline Adherence
  • Female
 

Citation

APA
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ICMJE
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Romano, M. M. D., Branco, M., Moreira, H. T., Schmidt, A., Kisslo, J., & Maciel, B. C. (2018). Appropriate use of echocardiography and relation to clinical decision making in both inpatients and outpatients in a developing country. Echocardiography, 35(1), 9–16. https://doi.org/10.1111/echo.13725
Romano, Minna Moreira Dias, Marina Branco, Henrique Turin Moreira, André Schmidt, Joseph Kisslo, and Benedito Carlos Maciel. “Appropriate use of echocardiography and relation to clinical decision making in both inpatients and outpatients in a developing country.Echocardiography 35, no. 1 (January 2018): 9–16. https://doi.org/10.1111/echo.13725.
Romano MMD, Branco M, Moreira HT, Schmidt A, Kisslo J, Maciel BC. Appropriate use of echocardiography and relation to clinical decision making in both inpatients and outpatients in a developing country. Echocardiography. 2018 Jan;35(1):9–16.
Romano, Minna Moreira Dias, et al. “Appropriate use of echocardiography and relation to clinical decision making in both inpatients and outpatients in a developing country.Echocardiography, vol. 35, no. 1, Jan. 2018, pp. 9–16. Pubmed, doi:10.1111/echo.13725.
Romano MMD, Branco M, Moreira HT, Schmidt A, Kisslo J, Maciel BC. Appropriate use of echocardiography and relation to clinical decision making in both inpatients and outpatients in a developing country. Echocardiography. 2018 Jan;35(1):9–16.
Journal cover image

Published In

Echocardiography

DOI

EISSN

1540-8175

Publication Date

January 2018

Volume

35

Issue

1

Start / End Page

9 / 16

Location

United States

Related Subject Headings

  • Referral and Consultation
  • Prospective Studies
  • Practice Patterns, Physicians'
  • Outpatients
  • Middle Aged
  • Male
  • Inpatients
  • Humans
  • Guideline Adherence
  • Female