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12-year Temporal Trend in Referral Pattern and Test Results of Stress Echocardiography in a Tertiary Care Referral Center with Moderate Volume Activities and Cath-lab Facility
- Source :
- Journal of Cardiovascular Echography
- Publication Year :
- 2018
-
Abstract
- Background: Data on stress echocardiography (SE) time-related changes in referral patterns and diagnostic yield for detection of inducible ischemia could enhance Echo Lab quality benchmarks and performance measures. Aim: This study aims to evaluate temporal trends in SE test results among ambulatory patients with suspected or known coronary artery disease (CAD) in a tertiary care referral center with moderate (>100/year) volume SE activities and Cath-Lab facility. Methods: From January 2004 to December 2015, 1954 patients (mean age 62 ± 12 years, 42% women, 27% with known CAD) underwent SE (1673 exercise SE, 86%, 246 pharmacological SE, 12%, 35 pacing SE, 2%). Time was grouped into three 4 year periods, where clinical data and test results were evaluated. Results: Our series comprised low-to-intermediate pretest probability of CAD throughout the observation period (overall pretest probability of CAD 19% ± 15%). A progressive decline over time in the rate of pharmacological SE instead of a dramatic increment of exercise SE (79%–96%, P < 0.0001) was noted. The use of beta-blockers increased (from 43% to 66%, P < 0.0001), while the use of nitrates decreased (from 11% to 4%, P < 0.0001) over time. We noted a very uncommon occurrence of abnormal test results with a further decrease in the last period (from 11% to 3%, P < 0.0001). Conclusions: We observed, over a 12-year period, a progressive decrease in the frequency of inducible myocardial ischemia among patients with known or suspected CADe referred to our Echo Lab for SE with Cath-Lab facility, and this trend was parallel to changes in SE referral practice. These findings are particularly relevant if we consider the practical implications on diagnostic SE accuracy and risk assessment.
- Subjects :
- medicine.medical_specialty
Referral
Cath lab
business.industry
stress echocardiography
030204 cardiovascular system & hematology
medicine.disease
Tertiary care
Coronary artery disease
Test (assessment)
Pre- and post-test probability
03 medical and health sciences
myocardial ischemia
0302 clinical medicine
Radiology, Nuclear Medicine and Imaging
Cardiology and Cardiovascular Medicine
Internal medicine
Ambulatory
Stress Echocardiography
Medicine
Radiology, Nuclear Medicine and imaging
Original Article
030212 general & internal medicine
business
Subjects
Details
- ISSN :
- 22114122
- Volume :
- 28
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Journal of cardiovascular echography
- Accession number :
- edsair.doi.dedup.....fe019fd39e3c41dce88255af65f9623f