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Patrizio Lancellotti, Madalina Garbi, The need for appropriate use criteria: the proof of the pudding, European Heart Journal - Cardiovascular Imaging, Volume 19, Issue 3, March 2018, Pages 269–270, https://doi.org/10.1093/ehjci/jex311
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This editorial refers to ‘Understanding decision-making in cardiac imaging: determinants of appropriate use’, by R. Fonseca et al., pp. 262–268.
Appropriateness criteria represent a physician-directed effort to define appropriate utilization of cardiac imaging procedures.1 Despite multiple iterations of appropriate use criteria (AUC), there is currently no evidence regarding their incorporation and impact on echocardiography ordering in daily practice. This article by Fonseca et al.2 used thematic analysis of the opinions of 17 doctors from an Australian tertiary hospital to identify determinants of appropriate use of echocardiography. The majority of the participants were trainees, including 1st year since graduation, and over 40% did not work within cardiology. There is no Australian AUC for the use of echocardiography, and only 23% of the participants had read the American AUC. The number of participants aware and following practice guidelines (e.g. for the management of heart valve disease or endocarditis) is not specified.
The use of echocardiography by the participants was assessed on hypothetical clinical cases and was found to be strongly discordant with the American AUC. There were inappropriate test requests and also failures to request appropriate tests, in clinical scenarios not only described in the American AUC but also supported by both European and American guidelines for the management of heart valve disease.
