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 journalArticle

1 Citation (Scopus)

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.

Original languageItalian
Pages (from-to)619-623
Number of pages5
JournalItalian Heart Journal Supplement
Volume3
Issue number6
Publication statusPublished - 2002

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Ambulatory Electrocardiography
Cardiology
Routine Diagnostic Tests
Prescriptions
Italy
Odds Ratio
Confidence Intervals
Cardiologists
Guidelines
Physicians
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Genovesi Ebert, A., Magnani, M., Galli, M., Lorenzoni, R., Macrì, R., Bernardi, D., ... Piccioni, N. (2002). La valutazione dell'appropriatezza della prescrizione dell'elettrocardiogramma dinamico secondo Holter. Italian Heart Journal Supplement, 3(6), 619-623.

La valutazione dell'appropriatezza della prescrizione dell'elettrocardiogramma dinamico secondo Holter. / Genovesi Ebert, Alberto; Magnani, Mirco; Galli, Michele; Lorenzoni, Roberto; Macrì, R.; Bernardi, D.; Volterrani, C.; Mazzoni, V.; Barletta, G.; Gensini, G. F.; Mazzuoli, F.; Zuppiroli, A.; Mori, F.; Pieri, F.; Vergassola, R.; Nannini, M.; Zambaldi, G.; Cerisano, S.; Landini, C.; Severi, S.; Digiorgio, A.; Venturini, C.; Raugi, M.; Baldini, U.; Savoia, M. T.; Paoletti, M.; Cortigiani, L.; Odoguardi, L.; Zanetti, L.; Lazzari, M.; Bonatti, V.; Giannini, R.; Vergoni, W.; Franchi, A.; De Tommasi, M.; Boem, A.; Fontanive, P.; Ferrante, G.; Baggiani, G.; Conti, U.; Cabani, E.; Del Citerna, F.; Bartolozzi, A.; Tonelli, L.; Baldini, P.; Tartarini, G.; Lattanzi, F.; Orsini, E.; Reishenofer, B.; Giaconi, S.; Levantesi, D.; Dabizzi, R.; Traini, A. M.; Mondanelli, D.; Magni, M.; Pesola, A.; Nevola, D.; Poddighe, R.; Mandorla, S.; Galiotto, S.; Saba, G.; Rey, L.; Provvidenza, M.; Piccioni, N.

In: Italian Heart Journal Supplement, Vol. 3, No. 6, 2002, p. 619-623.

Research output: Contribution to journalArticle

Genovesi Ebert, A, Magnani, M, Galli, M, Lorenzoni, R, Macrì, R, Bernardi, D, Volterrani, C, Mazzoni, V, Barletta, G, Gensini, GF, Mazzuoli, F, Zuppiroli, A, Mori, F, Pieri, F, Vergassola, R, Nannini, M, Zambaldi, G, Cerisano, S, Landini, C, Severi, S, Digiorgio, A, Venturini, C, Raugi, M, Baldini, U, Savoia, MT, Paoletti, M, Cortigiani, L, Odoguardi, L, Zanetti, L, Lazzari, M, Bonatti, V, Giannini, R, Vergoni, W, Franchi, A, De Tommasi, M, Boem, A, Fontanive, P, Ferrante, G, Baggiani, G, Conti, U, Cabani, E, Del Citerna, F, Bartolozzi, A, Tonelli, L, Baldini, P, Tartarini, G, Lattanzi, F, Orsini, E, Reishenofer, B, Giaconi, S, Levantesi, D, Dabizzi, R, Traini, AM, Mondanelli, D, Magni, M, Pesola, A, Nevola, D, Poddighe, R, Mandorla, S, Galiotto, S, Saba, G, Rey, L, Provvidenza, M & Piccioni, N 2002, 'La valutazione dell'appropriatezza della prescrizione dell'elettrocardiogramma dinamico secondo Holter', Italian Heart Journal Supplement, vol. 3, no. 6, pp. 619-623.
Genovesi Ebert A, Magnani M, Galli M, Lorenzoni R, Macrì R, Bernardi D et al. La valutazione dell'appropriatezza della prescrizione dell'elettrocardiogramma dinamico secondo Holter. Italian Heart Journal Supplement. 2002;3(6):619-623.
Genovesi Ebert, Alberto ; Magnani, Mirco ; Galli, Michele ; Lorenzoni, Roberto ; Macrì, R. ; Bernardi, D. ; Volterrani, C. ; Mazzoni, V. ; Barletta, G. ; Gensini, G. F. ; Mazzuoli, F. ; Zuppiroli, A. ; Mori, F. ; Pieri, F. ; Vergassola, R. ; Nannini, M. ; Zambaldi, G. ; Cerisano, S. ; Landini, C. ; Severi, S. ; Digiorgio, A. ; Venturini, C. ; Raugi, M. ; Baldini, U. ; Savoia, M. T. ; Paoletti, M. ; Cortigiani, L. ; Odoguardi, L. ; Zanetti, L. ; Lazzari, M. ; Bonatti, V. ; Giannini, R. ; Vergoni, W. ; Franchi, A. ; De Tommasi, M. ; Boem, A. ; Fontanive, P. ; Ferrante, G. ; Baggiani, G. ; Conti, U. ; Cabani, E. ; Del Citerna, F. ; Bartolozzi, A. ; Tonelli, L. ; Baldini, P. ; Tartarini, G. ; Lattanzi, F. ; Orsini, E. ; Reishenofer, B. ; Giaconi, S. ; Levantesi, D. ; Dabizzi, R. ; Traini, A. M. ; Mondanelli, D. ; Magni, M. ; Pesola, A. ; Nevola, D. ; Poddighe, R. ; Mandorla, S. ; Galiotto, S. ; Saba, G. ; Rey, L. ; Provvidenza, M. ; Piccioni, N. / La valutazione dell'appropriatezza della prescrizione dell'elettrocardiogramma dinamico secondo Holter. In: Italian Heart Journal Supplement. 2002 ; Vol. 3, No. 6. pp. 619-623.
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title = "La valutazione dell'appropriatezza della prescrizione dell'elettrocardiogramma dinamico secondo Holter",
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.",
keywords = "Appropriateness, Holter",
author = "{Genovesi Ebert}, Alberto and Mirco Magnani and Michele Galli and Roberto Lorenzoni and R. Macr{\`i} and D. Bernardi and C. Volterrani and V. Mazzoni and G. Barletta and Gensini, {G. F.} and F. Mazzuoli and A. Zuppiroli and F. Mori and F. Pieri and R. Vergassola and M. Nannini and G. Zambaldi and S. Cerisano and C. Landini and S. Severi and A. Digiorgio and C. Venturini and M. Raugi and U. Baldini and Savoia, {M. T.} and M. Paoletti and L. Cortigiani and L. Odoguardi and L. Zanetti and M. Lazzari and V. Bonatti and R. Giannini and W. Vergoni and A. Franchi and {De Tommasi}, M. and A. Boem and P. Fontanive and G. Ferrante and G. Baggiani and U. Conti and E. Cabani and {Del Citerna}, F. and A. Bartolozzi and L. Tonelli and P. Baldini and G. Tartarini and F. Lattanzi and E. Orsini and B. Reishenofer and S. Giaconi and D. Levantesi and R. Dabizzi and Traini, {A. M.} and D. Mondanelli and M. Magni and A. Pesola and D. Nevola and R. Poddighe and S. Mandorla and S. Galiotto and G. Saba and L. Rey and M. Provvidenza and N. Piccioni",
year = "2002",
language = "Italian",
volume = "3",
pages = "619--623",
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TY - JOUR

T1 - La valutazione dell'appropriatezza della prescrizione dell'elettrocardiogramma dinamico secondo Holter

AU - Genovesi Ebert, Alberto

AU - Magnani, Mirco

AU - Galli, Michele

AU - Lorenzoni, Roberto

AU - Macrì, R.

AU - Bernardi, D.

AU - Volterrani, C.

AU - Mazzoni, V.

AU - Barletta, G.

AU - Gensini, G. F.

AU - Mazzuoli, F.

AU - Zuppiroli, A.

AU - Mori, F.

AU - Pieri, F.

AU - Vergassola, R.

AU - Nannini, M.

AU - Zambaldi, G.

AU - Cerisano, S.

AU - Landini, C.

AU - Severi, S.

AU - Digiorgio, A.

AU - Venturini, C.

AU - Raugi, M.

AU - Baldini, U.

AU - Savoia, M. T.

AU - Paoletti, M.

AU - Cortigiani, L.

AU - Odoguardi, L.

AU - Zanetti, L.

AU - Lazzari, M.

AU - Bonatti, V.

AU - Giannini, R.

AU - Vergoni, W.

AU - Franchi, A.

AU - De Tommasi, M.

AU - Boem, A.

AU - Fontanive, P.

AU - Ferrante, G.

AU - Baggiani, G.

AU - Conti, U.

AU - Cabani, E.

AU - Del Citerna, F.

AU - Bartolozzi, A.

AU - Tonelli, L.

AU - Baldini, P.

AU - Tartarini, G.

AU - Lattanzi, F.

AU - Orsini, E.

AU - Reishenofer, B.

AU - Giaconi, S.

AU - Levantesi, D.

AU - Dabizzi, R.

AU - Traini, A. M.

AU - Mondanelli, D.

AU - Magni, M.

AU - Pesola, A.

AU - Nevola, D.

AU - Poddighe, R.

AU - Mandorla, S.

AU - Galiotto, S.

AU - Saba, G.

AU - Rey, L.

AU - Provvidenza, M.

AU - Piccioni, N.

PY - 2002

Y1 - 2002

N2 - 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.

AB - 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.

KW - Appropriateness

KW - Holter

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VL - 3

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JO - Italian Heart Journal Supplement

JF - Italian Heart Journal Supplement

SN - 1129-4728

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