La valutazione dell'appropriatezza della prescrizione dell'elettrocardiogramma dinamico secondo Holter

Translated title of the contribution: The evaluation of the appropriateness of prescription of non-invasive diagnostic tests in cardiology: The case of Holter monitoring

Alberto Genovesi Ebert, Mirco Magnani, Michele Galli, Roberto Lorenzoni, R. Macrì, D. Bernardi, C. Volterrani, V. Mazzoni, G. Barletta, G. F. Gensini, F. Mazzuoli, A. Zuppiroli, F. Mori, F. Pieri, R. Vergassola, M. Nannini, G. Zambaldi, S. Cerisano, C. Landini, S. SeveriA. Digiorgio, C. Venturini, M. Raugi, U. Baldini, M. T. Savoia, M. Paoletti, L. Cortigiani, L. Odoguardi, L. Zanetti, M. Lazzari, V. Bonatti, R. Giannini, W. Vergoni, A. Franchi, M. De Tommasi, A. Boem, P. Fontanive, G. Ferrante, G. Baggiani, U. Conti, E. Cabani, F. Del Citerna, A. Bartolozzi, L. Tonelli, P. Baldini, G. Tartarini, F. Lattanzi, E. Orsini, B. Reishenofer, S. Giaconi, D. Levantesi, R. Dabizzi, A. M. Traini, D. Mondanelli, M. Magni, A. Pesola, D. Nevola, R. Poddighe, S. Mandorla, S. Galiotto, G. Saba, L. Rey, M. Provvidenza, N. Piccioni

Research output: Contribution to journalArticlepeer-review

Abstract

Background. We evaluated the appropriateness of indications to Holter monitoring performed on ambulatory patients during 4 weeks in 21 laboratories in Tuscany and Umbria, Italy. Methods. We collected the following data: the appropriateness of the prescription (according to the guidelines of the Italian Federation of Cardiology), the prescribing physician (cardiologist vs non-cardiologist), the synthetic result (normal vs abnormal) and the clinical utility (useful vs useless) of each exam. Results. We evaluated 863 prescriptions (population: 435 males, 428 females; mean age 64 years, range 15-90 years). The indications to the test were of class I (appropriate) in 59.6%, of class II (doubtfully appropriate) in 11.7%, and of class III (inappropriate) in 28.7% of the cases. In 33% of the cases the exam was considered abnormal. In particular, an abnormal result was found in 37.9% of class I, in 36.7% of class II, and in 24.5 % of class III exams (p <0.05). The exam was considered useful in 46.7% of the cases. In particular, a useful result was found in 59.2% of class I, in 45.5% of class II, and in 21% of class III exams (p <0.05). Cardiologists prescribed 373/863 tests (43.2%). Their indications were of class I in 67.6%, of class II in 12% and of class III in 24% of the cases vs 53.7,11.4 and 34.9% of non-cardiologists' prescriptions (p <0.05). Abnormal findings were found in 40% of cardiologist- vs 27.6% of non-cardiologist-prescribed examinations (odds ratio 1.74, 95% confidence interval 1.31-2.32; p <0.05); similarly, clinically useful information could be derived from 59.8% of cardiologist- vs 36.7% of non-cardiologist-prescribed examinations (odds ratio 2.56, 95% confidence interval 1.94-3.37; p <0.05). Conclusions. In Tuscany and Umbria, Italy, about 40% of Holter exams are inappropriate; appropriately prescribed exams are more often abnormal and useful; cardiologist-prescribed exams are significantly more appropriate, abnormal and useful.

Translated title of the contributionThe evaluation of the appropriateness of prescription of non-invasive diagnostic tests in cardiology: The case of Holter monitoring
Original languageItalian
Pages (from-to)619-623
Number of pages5
JournalItalian Heart Journal Supplement
Volume3
Issue number6
Publication statusPublished - 2002

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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