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

Danielle Louis Villanueva; Marion Patricio; Jose Donato Magno; Felix Eduardo Punzalan

doi:doi:10.11648/j.ccr.20200402.11

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

Danielle Louis Villanueva, Marion Patricio, Jose Donato Magno, Felix Eduardo Punzalan

Published in Cardiology and Cardiovascular Research (Volume 4, Issue 2)

Received: 6 March 2020 Accepted: 23 March 2020 Published: 14 April 2020

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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.

Published in	Cardiology and Cardiovascular Research (Volume 4, Issue 2)
DOI	10.11648/j.ccr.20200402.11
Page(s)	27-33
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

AUC, Appropriateness Use Criteria, Transthoracic 2d-echo, Philippine General Hospital, Philippine Echocardiography

References

[1]	Philippine General Hospital Statistics. 2013. PGH Statistics [unpublished].
[2]	Division of Cardiovascular Medicine, Department of Medicine, Report of Echo Statistics. 2017. [unpublished].
[3]	Amita Singh and R. Parker Ward. 2016. Appropriate Use Criteria for Echocardiography: Evolving Applications in the Era of Value-Based Healthcare. Curr Cardiol Rep. 2016 September; 18 (9): 93.
[4]	Douglas P, Garcia, M, Haines, D, et. al. 2011. Appropriate Use Criteria for Echocardiography. J Am Soc Echocardiography, 2011; 24: 229-67.
[5]	Magno, Jose Donato. 2018. Clinical Echocardiography Appropriate Use Criteria (The CLEAR Guidelines) for Transthoracic 2-dimensional Echocardiography (2018 Update). [unpublished].
[6]	Byrd BF 3^rd, Abraham TP, Buxton DB, et al. 2015. A Summary of the American Society of echocardiography foundation value based healthcare summit 2014: The role of cardiovascular ultrasound in the new paradigm. J Am Soc Echocardiogr: Off Publ Am Soc Echocardiogr; 28: 755-69.
[7]	Gurzun MM and Ionescu A. 2014. Appropriateness of use criteria for transthoracic echocardiography: are they relevant outside the USA. Eur Heart J Cardiovasc Imaging; 15 (4): 450–5.
[8]	Patil HR, Coggins TR, Kusnetzky LL, et al. Evaluation of appropriate use of transthoracic echocardiography in 1,820 consecutive patients using the 2011 revised appropriate use criteria for echocardiography. Am J Cardiol. 2012; 109 (12): 1814–7.
[9]	Kerley RN, Thornton KP, Kelly RM, et al. 2018. Appropriate use criteria for transthoracic echocardiography: Are they relevant to European Centers. Jan; 35 (1): 17-23. Epub 2017 Nov 21.
[10]	Al-Kaisey A, Jones E, Nadurata V, et al. 2015. Appropriateness use of echocardiography in an Australian Regional Centre. Intern Med J. 2015; 45 (11): 1128–33).
[11]	Bailey SA, Mosteanu I, Tietjen PA, et al. 2012. The use of transthoracic echocardiography and adherence to appropriate use criteria at a regional hospital. J Am Soc Echocardiogr. 2012; 25 (9): 1015–22.
[12]	Ballo P, Bandini F, Capecchi I, et al. 2012. Application of 2011 American College of Cardiology Foundation/American Society of Echocardiography appropriateness use criteria in hospitalized patients referred for transthoracic echocardiography in a community setting. J Am Soc Echocardiogry. 2012; 25 (6): 589–98.
[13]	Matulevicius SA, Rohatgi A, Das SR, Price AL, DeLuna A, Reimold SC. Appropriate use and clinical impact of transthoracic echocardiography. JAMAIntern Med. 2013; 173 (17): 1600–7.
[14]	Bhatia RS, Milford CE, Picard MH, Weiner RB. An educational intervention reduces the rate of inappropriate echocardiograms on an inpatient medical service. JACC Cardiovasc Imaging. 2013; 6 (5): 545–55.
[15]	Ioannidis JP. Appropriate vs clinically useful diagnostic tests. JAMA Intern Med. 2013; 173 (17): 1607–9.

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APA Style

Danielle Louis Villanueva, Marion Patricio, Jose Donato Magno, Felix Eduardo Punzalan. (2020). Appropriateness Use Criteria of Trans-Thoracic 2D-Echocardiography Among Adult Patients in the Philippine General Hospital. Cardiology and Cardiovascular Research, 4(2), 27-33. https://doi.org/10.11648/j.ccr.20200402.11

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ACS Style

Danielle Louis Villanueva; Marion Patricio; Jose Donato Magno; Felix Eduardo Punzalan. Appropriateness Use Criteria of Trans-Thoracic 2D-Echocardiography Among Adult Patients in the Philippine General Hospital. Cardiol. Cardiovasc. Res. 2020, 4(2), 27-33. doi: 10.11648/j.ccr.20200402.11

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AMA Style

Danielle Louis Villanueva, Marion Patricio, Jose Donato Magno, Felix Eduardo Punzalan. Appropriateness Use Criteria of Trans-Thoracic 2D-Echocardiography Among Adult Patients in the Philippine General Hospital. Cardiol Cardiovasc Res. 2020;4(2):27-33. doi: 10.11648/j.ccr.20200402.11

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@article{10.11648/j.ccr.20200402.11,
  author = {Danielle Louis Villanueva and Marion Patricio and Jose Donato Magno and Felix Eduardo Punzalan},
  title = {Appropriateness Use Criteria of Trans-Thoracic 2D-Echocardiography Among Adult Patients in the Philippine General Hospital},
  journal = {Cardiology and Cardiovascular Research},
  volume = {4},
  number = {2},
  pages = {27-33},
  doi = {10.11648/j.ccr.20200402.11},
  url = {https://doi.org/10.11648/j.ccr.20200402.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20200402.11},
  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.},
 year = {2020}
}

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TY - JOUR
T1 - Appropriateness Use Criteria of Trans-Thoracic 2D-Echocardiography Among Adult Patients in the Philippine General Hospital
AU - Danielle Louis Villanueva
AU - Marion Patricio
AU - Jose Donato Magno
AU - Felix Eduardo Punzalan
Y1 - 2020/04/14
PY - 2020
N1 - https://doi.org/10.11648/j.ccr.20200402.11
DO - 10.11648/j.ccr.20200402.11
T2 - Cardiology and Cardiovascular Research
JF - Cardiology and Cardiovascular Research
JO - Cardiology and Cardiovascular Research
SP - 27
EP - 33
PB - Science Publishing Group
SN - 2578-8914
UR - https://doi.org/10.11648/j.ccr.20200402.11
AB - 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.
VL - 4
IS - 2
ER -

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Author Information

Danielle Louis Villanueva

Department of Medicine, University of the Philippines - Philippine General Hospital, Manila, Philippines
Marion Patricio

Department of Medicine, University of the Philippines - Philippine General Hospital, Manila, Philippines
Jose Donato Magno

Department of Medicine, University of the Philippines - Philippine General Hospital, Manila, Philippines
Felix Eduardo Punzalan

Department of Medicine, University of the Philippines - Philippine General Hospital, Manila, Philippines

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APA Style

Danielle Louis Villanueva, Marion Patricio, Jose Donato Magno, Felix Eduardo Punzalan. (2020). Appropriateness Use Criteria of Trans-Thoracic 2D-Echocardiography Among Adult Patients in the Philippine General Hospital. Cardiology and Cardiovascular Research, 4(2), 27-33. https://doi.org/10.11648/j.ccr.20200402.11

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ACS Style

Danielle Louis Villanueva; Marion Patricio; Jose Donato Magno; Felix Eduardo Punzalan. Appropriateness Use Criteria of Trans-Thoracic 2D-Echocardiography Among Adult Patients in the Philippine General Hospital. Cardiol. Cardiovasc. Res. 2020, 4(2), 27-33. doi: 10.11648/j.ccr.20200402.11

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AMA Style

Danielle Louis Villanueva, Marion Patricio, Jose Donato Magno, Felix Eduardo Punzalan. Appropriateness Use Criteria of Trans-Thoracic 2D-Echocardiography Among Adult Patients in the Philippine General Hospital. Cardiol Cardiovasc Res. 2020;4(2):27-33. doi: 10.11648/j.ccr.20200402.11

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@article{10.11648/j.ccr.20200402.11,
  author = {Danielle Louis Villanueva and Marion Patricio and Jose Donato Magno and Felix Eduardo Punzalan},
  title = {Appropriateness Use Criteria of Trans-Thoracic 2D-Echocardiography Among Adult Patients in the Philippine General Hospital},
  journal = {Cardiology and Cardiovascular Research},
  volume = {4},
  number = {2},
  pages = {27-33},
  doi = {10.11648/j.ccr.20200402.11},
  url = {https://doi.org/10.11648/j.ccr.20200402.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20200402.11},
  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.},
 year = {2020}
}

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