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(Referência obtida automaticamente do Web of Science, por meio da informação sobre o financiamento pela FAPESP e o número do processo correspondente, incluída na publicação pelos autores.)

Appropriate use of echocardiography and relation to clinical decision making in both inpatients and outpatients in a developing country

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Autor(es):
Dias Romano, Minna Moreira [1] ; Branco, Marina [1] ; Moreira, Henrique Turin [1] ; Schmidt, Andre [1] ; Kisslo, Joseph [2] ; Maciel, Benedito Carlos [1]
Número total de Autores: 6
Afiliação do(s) autor(es):
[1] Univ Sao Paulo, Med Sch Ribeirao Preto, Cardiol Ctr, Ribeirao Preto, SP - Brazil
[2] Duke Univ, Dept Med, Div Cardiol, Durham, NC - USA
Número total de Afiliações: 2
Tipo de documento: Artigo Científico
Fonte: ECHOCARDIOGRAPHY-A JOURNAL OF CARDIOVASCULAR ULTRASOUND AND ALLIED TECHNIQUES; v. 35, n. 1, p. 9-16, JAN 2018.
Citações Web of Science: 1
Resumo

BackgroundUse of echocardiography (echo) has exponentially increased in recent decades. Concerned about this scientific society developed appropriate use criteria (AUC). Clinical management still suffers geographical variations, and no objective data are available about echo AUC in developing countries. We aimed to evaluate (1) the appropriateness of referrals and (2) their relation to changes in clinical decision management. MethodsProspective analysis of referrals from January to December 2014. Appropriateness and endpoints analyzed in different time points from medical archives. Endpoints: (1) change in the diagnosis, (2) indication for another method to complete the diagnosis, (3) change in clinical treatment, (4) indication for a treatment intervention, or (5) no change in management. Descriptive statistical analysis, Fisher's or chi-square tests, and Cox regression used as appropriate (significance if P<.05). ResultsOne thousand one hundred referrals were analyzed (55.516.1years, 44.6% male). 80.5% of referrals were appropriate (A), 11.2% Rarely Appropriate (RA), and 8.3% May Be Appropriate (MBA). Proportion of (A) did not differ between modalities (TTE-80.5% vs TEE-87.7% vs STR-81.2%, P=.67). (A) referrals were more related to clinical decision than (RA)+(MBA) (38.9% {[}A] vs 15% {[}RA]+{[}MBA], P<.001). The most frequent clinical indications of (RA) and (MBA) TTE were reevaluation of ventricular function without clinical change (AUC 10 and 11) and search of infectious endocarditis when low clinical probability (53). ConclusionsIn a developing country, appropriateness of echo was similar to the United States and Europe. However, a significant proportion of referrals were still (RA) or (MBA), with no effect in clinical management. Controlling referrals 10, 11, and 53 can optimize echo use in developing countries. (AU)

Processo FAPESP: 13/06099-9 - Avaliação da adequação de indicações de exames ecocardiográficos e de seu valor prognóstico em centro de diagnóstico cardiológico de atenção terciária
Beneficiário:Minna Moreira Dias Romano
Linha de fomento: Auxílio à Pesquisa - Regular