Uso inapropriado da ecocardiografia transtorácica, segundo recomendações da SBC

Barachi, Laiz Boniziolli; Barbosa, Flávia Candolo Pupo; Moscavitch, Samuel-Datum; Pilon, Barbara; Pissinati, Gabriela Vescovi; Mesquita, Evandro Tinoco; Mesquita, Cláudio Tinoco; Santos, Maitê Telles dos

doi:10.1590/s0066-782x2012001300012

Cited by 2 publications

(1 citation statement)

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“…Some studies showed a marked increase in the number of echocardiogram requests in recent years (6–8% per year) ( 3 , 5 ). In Brazil (2010), 715,655 elective echocardiograms were performed in outpatients in the Unified Health System (SUS), and 425.317 (59%) of them were performed in the southeastern region of the country, with an estimated cost of over R$ 30 million ( 6 ), contributing to a progressive increase of public health costs ( 7 ).…”

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confidence: 99%

Low prevalence of relevant findings in inappropriate echocardiograms and discordant perceptions between cardiologists and patients

Lopes

Oliveira

Ríos³

et al. 2018

Braz J Med Biol Res

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Complementary examinations are “inadequate” whenever the likelihood of benefits from their indication is lower than the negative results. The low benefit is a result of poor performance in detecting relevant changes that lead to improved behavior. However, inadequate examinations are prevalent and little is known about patients' notions of the usefulness of such indications. The aim of this study was to describe relevant findings in inappropriate echocardiograms and to assess the level of agreement between patients and cardiologists regarding their usefulness. Adults without known cardiovascular disease who were referred for echocardiogram by inappropriate criteria according to the American College of Cardiology were selected. Relevant findings were defined by any change in the degree of moderate to severe, according to the American Society of Echocardiography. We tested the level of agreement between the patients who underwent echocardiographic examination and the physicians who requested the exam through a standard questionnaire. Five hundred patients were included, with average age of 52±17 years (47% males). Only 17 patients had any relevant changes (3.4%, 95%CI=2 to 5.4%). The most frequent alterations included valve changes in 8 and diastolic dysfunction grade II in 6 patients. Eighty-seven examinations were performed to determine the level of agreement between patients and cardiologists. For the question “Is this test really necessary?”, 92% of patients responded positively, compared with 5% of cardiologists (Kappa negative 0.04; P=0.01). The frequency of relevant findings was low in inadequate echocardiograms and patients and cardiologists had a different perception regarding its usefulness.

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