ArticleClinical cardiology2015
Application of appropriate use criteria to cardiac stress testing in the hospital setting: limitations of the criteria and areas for improved practice.
Article in Clinical cardiology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Appropriate Use of Cardiac Stress Testing with Imaging: A Systematic Review and Meta-Analysis.PloS one · 2016Pooled it
- The Proteome Profile of Stress Test Assessed Cardiovascular Disease Risk-Prone Diabetic Subjects.Journal of cardiovascular translational research · 2025Article
- Computer-Assisted Protocol-Adherent Blood Lipid Evaluation in Vascular Outpatients (CAPABLE-Vascular).Journal of clinical medicine · 2025Article
- Appropriateness of inpatient stress testing: Implications for development of clinical decision support mechanisms and future criteria.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2021Article
- Appropriate use criteria implementation with modified Haller index for predicting stress echocardiographic results and outcome in a population of patients with suspected coronary artery disease.The international journal of cardiovascular imaging · 2021Article
- Using a sledgehammer to crack a nut: The burdensome appropriate use criteria program.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2021Article
- Adherence to American Heart Association and American College of Cardiology guidelines for exercise tolerance test in cardiovascular clinics.Journal of cardiovascular and thoracic research · 2019Article
- Study to Evaluate Current Trends in Appropriate Usage of Tread Mill Exercise Testing.Journal of clinical and diagnostic research : JCDR · 2016Article
- Outcomes after inappropriate nuclear myocardial perfusion imaging: A meta-analysis.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2016Review
- Impact of insurance carrier, prior authorization, and socioeconomic status on appropriate use of SPECT myocardial perfusion imaging in private community-based office practice.Clinical cardiology · 2015Article
- Metrics of quality care in veterans: correlation between primary-care performance measures and inappropriate myocardial perfusion imaging.Clinical cardiology · 2015Article
- Appropriate use criteria in myocardial perfusion imaging in a tertiary care hospital in South India: An audit.World journal of nuclear medicineArticle
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundImaging cardiac stress test use has risen significantly, leading to the development of appropriate use criteria. Prior studies have suggested the rate of inappropriate testing is 13% to 14%, but inappropriate testing in hospitalized patients has not been well studied. HYPOTHESIS: Appropriate use of stress testing in hospitalized patients is not comparable to the ambulatory setting.
methodsWe studied 459 consecutive patients referred for imaging stress tests (nuclear imaging or stress echocardiography) at a single institution over a 6-month period. Appropriate use was determined by research cardiologists blinded to patient outcomes.
resultsMost tests (68%) were in patients with chest pain or possible acute coronary syndrome (ACS). Another 20% were for preoperative evaluation. The rate of inappropriate testing was 13%. Imaging modality did not correlate with appropriate use. Only 2% of the chest pain or possible ACS were inappropriate, compared to 49% of the preoperative exams (P < 0.001). The most common reason a test was considered inappropriate was for a low-risk patient for preoperative exam (77% of inappropriate tests). Using Thrombolysis in Myocardial Infarction score 0 to define inappropriate testing in the possible ACS cohort might make an additional 27% inappropriate.
conclusionsThe rate of inappropriate use of cardiac stress testing with imaging in the inpatient setting is similar to that in the ambulatory setting. However, there is wide variation in inappropriate testing based on the indication for the test. Taking risk into consideration in possible ACS patients could result in a larger number of tests being considered inappropriate.
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