Comparison of the Clinical Application of the American College of Cardiology Foundation/American Society of Echocardiography Appropriateness Criteria for Outpatient Transthoracic Echocardiography in Academic and Community Practice Settings
published online 22 September 2009.
Background
We sought to compare the clinical application of the American College of Cardiology Foundation/American Society of Echocardiography Appropriateness Criteria (AC) for outpatient transthoracic echocardiography (TTE) in academic and community practice settings.
Methods
Indications for TTE ordered in both academic and community practice settings were determined by 2 reviewers and categorized according to the AC for TTE as Appropriate, Inappropriate, or Not Addressed. Patient characteristics, ordering physician specialty, and TTE findings were also recorded.
Results
Overall, 814 academic and 319 community TTEs were analyzed. Interobserver variability for indication determination was high and did not differ between studies ordered at the 2 practice settings. Compared with the academic practice, community practice TTE indications were more likely to be classified in the AC for TTE (88% vs 82%, P = .04), but were ordered for a similar frequency of Appropriate (71% vs 68%, P = not significant) and Inappropriate (17% vs 15%, P = not significant) indications. New important TTE abnormalities were more frequently found in Appropriate studies compared with Inappropriate studies in both academic (35% vs 16%, P < .001) and community practice (29% vs 15%, P = .04) settings.
Conclusion
The clinical application of the AC for TTE is feasible, and the frequency of Appropriate and Inappropriate outpatient TTEs is similar in academic and community practice settings. However, limitations of the AC for TTE are identified that suggest revisions will be needed to fully encompass and stratify the broad clinical practice of echocardiography.
Non-Invasive Imaging Laboratories, Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois; and Illinois Heart and Vascular, Hinsdale, Illinois
Reprint requests: R. Parker Ward, MD, Associate Professor of Medicine, University of Chicago Medical Center, 5841 S. Maryland Avenue, RM 611B, MC6080, Chicago, IL 60637.
This study was sponsored by a grant from the American Society of Echocardiography.
ABSTRACT