ANN ARBOR, Mich. -- Cardiologists at the University of Michigan Frankel Cardiovascular Center provide an invited commentary in this week's JAMA Internal Medicine on the use of heart tests, and whether they provide the answers patients and doctors need.
William Armstrong, M.D., and Kim A. Eagle, M.D., a director of the Cardiovascular Center write: “Matulevicius and colleagues compare the clinical impact of transthoracic echocardiograms (TTEs) with the classification of the echocardiogram by the 2011 appropriate use criteria (AUC).
"They find that, although 91.8 percent of TTEs were appropriate, only 1 in 3 resulted in an active change in clinical management; approximately 1 in 2, in continuation of current care; and approximately 20 percent, in no change in current care.
“The degree to which these outcomes are exclusively shortcomings of the AUC is debatable but raises concerns that further modifications – and probably physician education – are necessary to achieve a more efficient use of echocardiography and conserve resources,” they continue.
Dr. Kim Eagle and Dr. William Armstrong
“The AUC are under a constant state of iteration and investigation; clearly the 2011 revision addresses many of the shortcomings of the earlier versions. Certainly, the AUC are not without remaining flaws and ideally should result in a categorization scheme that can be demonstrated to have a consistent, but not necessarily invariable, effect on medical decision making.
"This retrospective study points the way for further prospective studies looking at the impact of echocardiography and how it affects physician decision-making,” they conclude.
Reference: JAMA Intern. Med. 2013 July 22 [doi:10.1001/jamainternmed.2013.7273