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• W2893711929 abstract "Unnecessary echocardiograms constitute a failure of efficient allocation of scarce Canadian health care resources. Consensus-based guidelines developed by the former Cardiac Care Network of Ontario (CCN) are used to determine appropriateness of the indication for echocardiograms conducted in Ontario. Similarly, the appropriateness of use (AUC) criteria have been developed by the American College of Cardiology Foundation to direct appropriate utilization of echocardiography. This study examined the level of agreement between these guidelines for transthoracic echocardiograms (TTE) conducted in Ontario. This retrospective study examined a Canadian subset of the previously published EchoWISELY trial, which included TTEs conducted December 2014 - April 2016 at seven academic hospitals in Ontario. Indications for 10,081 TTEs were classified as appropriate or inappropriate based on AUC and CCN criteria. For this study, uncertainty in AUC classification was included with appropriate. We used McNemar’s test to investigate guideline discordance for the overall number of TTEs, and in heart failure and valvular disease. Overall, AUC and CCN guidelines disagreed on the appropriateness of 983 (9.8%) of echocardiograms (p<0.0001). In 230 of these, CCN determined that a TTE was appropriate whereas the AUC determined it was inappropriate; in 753 of these, AUC criteria determined it was appropriate or uncertain in proceeding with a TTE whereas the CCN guidelines did not indicate a TTE. In 969 (9.6%) cases, a TTE was inappropriately ordered according to both AUC and CCN guidelines. For heart failure, AUC and CCN guidelines disagreed on the appropriateness of 327 (12%) of TTEs (p<0.0001). In nine of these, CCN determined that a TTE was appropriate whereas the AUC determined it was inappropriate; in 318 of these, AUC criteria allowed for a TTE whereas the CCN guidelines had no indication for a TTE. For valvular disease, AUC and CCN guidelines disagreed on the appropriateness of 281 (9.5%) of TTEs (p<0.0001). In 194 of these, CCN determined that a TTE was appropriate whereas the AUC determined it was inappropriate; in 87 of these, AUC criteria allowed for a TTE whereas the CCN guidelines did not indicate a TTE. Although AUC and CCN guidelines had a high level of agreement, there was lower agreement for appropriateness of TTEs in heart failure. If AUC guidelines were to be implemented in Ontario, there would likely be an increase in TTEs, except for valvular disease, where more CCN-appropriate echocardiograms were found to be inappropriate by AUC." @default.
• W2893711929 created "2018-10-05" @default.
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• W2893711929 date "2018-10-01" @default.
• W2893711929 modified "2023-09-25" @default.
• W2893711929 title "COMPARING GUIDELINES FOR TTE APPROPRIATENESS IN ECHOWISELY: THE APPROPRIATE USE CRITERIA VS. CARDIAC CARE NETWORK OF ONTARIO" @default.
• W2893711929 doi "https://doi.org/10.1016/j.cjca.2018.07.408" @default.
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