La valutazione dell'appropriatezza della prescrizione del test da sforzo

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

Enrico Orsini, Francesco Mazzuoli, Leonardo Odoguardi, Mirco Magnani, Roberto Lorenzoni, R. Macrì, D. Bernardi, C. Volterrani, V. Mazzoni, G. Barletta, G. F. Gensini, A. Zuppiroli, F. Mori, F. Pieri, R. Vergassola, M. Nannini, G. Zambaldi, S. Cerisano, C. Landini, S. SeveriA. Genovesi Ebert, A. Digiorgio, C. Venturini, M. Raugi, U. Baldini, M. T. Savoia, M. Paoletti, L. Cortigiani, 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, B. Reishenofer, S. Giaconi, D. Levantesi, R. Dabizzi, A. M. Traini, D. Mondanelli, M. Magni Viareggio, A. Pesola, D. Nevola, R. Poddighe, S. Mandorla, S. Galiotto, G. Saba, L. Rey, M. Provvidenza, N. Piccioni

Research output: Contribution to journalArticle

Abstract

Background. We evaluated the appropriateness of the indications to exercise testing for ambulatory patients performed 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 1158 prescriptions (population: 822 males, 336 females; mean age 60 years, range 16-82 years). Prescriptions were of class I (appropriate) in 38.9%, of class II (of doubtful appropriateness) in 52.5% and of class III (inappropriate) in 8.6% of the cases. In 14.2% of the cases the exam was abnormal: it was abnormal in 35.5% of class I, in 26.6% of class II and in 23% of class III exams (p <0.05). The exam was useful in 51.6% of the cases; it was useful in 62.4% of class I, in 50.2% of class II and in 13% of class III exams (p <0.05). Cardiologists required 596/1158 tests (51.5%). Their indications were included in class I in 45.6%, in class II in 49.7% and in class III in 4.7% of the cases vs 31.7, 55.5 e 12.8% of non-cardiologists' prescriptions (p <0.05). The test was abnormal in 35.7% of cardiologist vs 23.5% of non-cardiologist-prescribed examinations (odds ratio 1.81, 95% confidence interval 1.4-2.34; p <0.05); the test was useful in 64.4% of cardiologist vs 38.2% of non-cardiologist-prescribed exams (odds ratio 2.92, 95% confidence interval 2.3-3.71; p <0.05). Conclusions. In Tuscany and Umbria, Italy, less than half of exercise testing procedures are appropriate; 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 exercise test
Original languageItalian
Pages (from-to)624-629
Number of pages6
JournalItalian Heart Journal Supplement
Volume3
Issue number6
Publication statusPublished - 2002

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Orsini, E., Mazzuoli, F., Odoguardi, L., Magnani, M., Lorenzoni, R., Macrì, R., Bernardi, D., Volterrani, C., Mazzoni, V., Barletta, G., Gensini, G. F., Zuppiroli, A., Mori, F., Pieri, F., Vergassola, R., Nannini, M., Zambaldi, G., Cerisano, S., Landini, C., ... Piccioni, N. (2002). La valutazione dell'appropriatezza della prescrizione del test da sforzo. Italian Heart Journal Supplement, 3(6), 624-629.