Transthoracic echocardiography (TTE) and computed tomography angiography (CTA) have shown improvements in the rates of reported appropriate use, in contrast to stress imaging and transesophageal echocardiography (TEE), according to a study published Feb. 23 in the Journal of the American College of Cardiology.

Analyzing data from 59 papers with 103,567 tests related to appropriate use criteria (AUC) and cardiovascular imaging, which were published between 2000 and 2012, researchers sought to determine the proportion of appropriate tests within the total sample of each report. Researchers evaluated studies from five online databases, including PubMed, Scopus, Web of Science, Embase and Cochrane. Papers were included in the meta-analysis if authors reported the following information: use of AUC; year of data collection; sample size of tests; proportion of imaging studies and uncertain/rarely appropriate tests; and proportion of classified or unclassified tests.

The results of the meta-analysis showed that updated or new AUC were associated with improvements in appropriateness for TTE, TEE and CTA but not stress echocardiography or single-photon emission computed tomography. In a meta-regression measuring the rate of appropriate testing over time, researchers found a positive correlation between the proportion of appropriate TTEs and the 2011 AUC. However, a significant decrease was found in the proportion of appropriateness for the 2007 TEE AUC.

The authors note that “in contrast to reports comparing the behavior of specific groups of physicians over time, the results [of our study] are an indication of ‘real-world’ practice at sites publishing their appropriate use data.”

The study “suggests that the AUC have had limited impact on physician test ordering, with only small and inconsistent changes seen in the number of appropriate and rarely appropriate studies,” state Todd D. Miller, MD, FACC, and J. Wells Askew, MD , FACC, in an accompanying editorial comment. “In the future, imaging laboratories will be required to demonstrate efforts to monitor the appropriateness testing for accreditation and reimbursement purposes. These requirements...should significantly influence test ordering and enhance the efficacy of imaging.”

Keywords: Accreditation, Angiography, Cardiac Imaging Techniques, Echocardiography, Echocardiography, Stress, Echocardiography, Transesophageal, PubMed, Publishing, Research Personnel, Sample Size, Tomography, Emission-Computed, Single-Photon

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