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[Evaluation of the appropriateness of prescribing Holter dynamic electrocardiography].
[Evaluation of the appropriateness of prescribing Holter dynamic electrocardiography].
- Source :
-
Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology [Ital Heart J Suppl] 2002 Jun; Vol. 3 (6), pp. 619-23. - Publication Year :
- 2002
-
Abstract
- Background: We evaluated the appropriateness of indications to Holter monitoring performed on ambulatory patients during 4 weeks in 21 laboratories in Tuscany and Umbria, Italy.<br />Methods: We collected the following data: the appropriateness of the prescription (according to the guidelines of the Italian Federation of Cardiology), the prescribing physician (cardiologist vs non-cardiologist), the synthetic result (normal vs abnormal) and the clinical utility (useful vs useless) of each exam.<br />Results: We evaluated 863 prescriptions (population: 435 males, 428 females; mean age 64 years, range 15-90 years). The indications to the test were of class I (appropriate) in 59.6%, of class II (doubtfully appropriate) in 11.7%, and of class III (inappropriate) in 28.7% of the cases. In 33% of the cases the exam was considered abnormal. In particular, an abnormal result was found in 37.9% of class I, in 36.7% of class II, and in 24.5% of class III exams (p < 0.05). The exam was considered useful in 46.7% of the cases. In particular, a useful result was found in 59.2% of class I, in 45.5% of class II, and in 21% of class III exams (p < 0.05). Cardiologists prescribed 373/863 tests (43.2%). Their indications were of class I in 67.6%, of class II in 12% and of class III in 24% of the cases vs 53.7, 11.4 and 34.9% of non-cardiologists' prescriptions (p < 0.05). Abnormal findings were found in 40% of cardiologist- vs 27.6% of non-cardiologist-prescribed examinations (odds ratio 1.74, 95% confidence interval 1.31-2.32; p < 0.05); similarly, clinically useful information could be derived from 59.8% of cardiologist- vs 36.7% of non-cardiologist-prescribed examinations (odds ratio 2.56, 95% confidence interval 1.94-3.37; p < 0.05).<br />Conclusions: In Tuscany and Umbria, Italy, about 40% of Holter exams are inappropriate; appropriately prescribed exams are more often abnormal and useful; cardiologist-prescribed exams are significantly more appropriate, abnormal and useful.
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Ambulatory Care standards
Cardiology statistics & numerical data
Evaluation Studies as Topic
Female
Humans
Italy
Male
Medicine standards
Medicine statistics & numerical data
Middle Aged
Odds Ratio
Predictive Value of Tests
Specialization
Utilization Review
Cardiology standards
Electrocardiography, Ambulatory standards
Electrocardiography, Ambulatory statistics & numerical data
Practice Patterns, Physicians' statistics & numerical data
Subjects
Details
- Language :
- Italian
- ISSN :
- 1129-4728
- Volume :
- 3
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 12116811