Appropriateness Use Criteria of Trans-Thoracic 2D-Echocardiography Among Adult Patients in the Philippine General Hospital

Abstract

BACKGROUND There is an increasing utilization rate and clinical importance of performing echocardiography especially in a tertiary referral center such as the UP-PGH. An appropriate use criteria (AUC) in echocardiography is essential to improve clinical outcomes while preserving hospital and patient resources. METHODS We reviewed the echocardiographic requests of patients referred for transthoracic 2d-echocardiography. Echocardiography indication were documented mainly using the echocardiography order/request form. The echocardiography indications were adjudicated by at least two investigators. If there was more than one indication that fit into the AUC 2011, the most appropriate one was retained. RESULTS A total of 1006 echocardiographic requests were included in this study. The patients were predominantly males (68.2%) and with a mean age of 56.27 ± 16.89. majority of the referrals came from the medicine wards (37.3%). The top three cardiac diagnosis are: Heart Failure (25.9%), Acute Coronary Syndrome (20.7%) and Hypertension (15.5%). Of the top 15 most common indications, 11 were appropriate while 2 were maybe appropriate, and 2 were rarely appropriate. The three most common specific indication is the evaluation for heart failure (21.4%), the search for a cardiac etiology for a particular symptom (14.3%) and the initial evaluation of a suspected hypertensive heart disease (9.9%). The most common rarely appropriate indication is the routine perioperative evaluation of ventricular function (5.5%). Majority of the echocardiography requests have appropriate indications (87.9%). CONCLUSION This is the first application of the AUC to the transthoracic 2d-echo here in the Philippines. The transthoracic 2D-echocardiography done in the Philippine General Hospital have mostly appropriate indications.