Appropriate Use of Transthoracic Echocardiography

The appropriateness criteria for echocardiography were published in 2007 and classified potential procedural indications as appropriate, uncertain, or inappropriate. The appropriate use rates for outpatient transthoracic echocardiography (TTE) by cardiologists have not been well defined. The objective of the present study was to prospectively determine the appropriate use rate of outpatient TTE in a large private practice group of >40 cardiologists (Cardiovascular Consultants, PA, Kansas City, Missouri). For each transthoracic echocardiographic study, we classified the stated reason for the examination into one of the 59 indications specified in the 2007 Appropriateness Criteria for Echocardiography publication. During the study period, 772 transthoracic echocardiographic studies were performed. Adequate information was available to classify 716 (92.7%) of these studies. The transthoracic echocardiographic studies were appropriately ordered for 533 patients (74%). Symptoms of potential cardiac origin (eg, dyspnea) was the most common reason for TTE (n = 156, 21.8%). The most common inappropriate use was routine repeat evaluation of patients with heart failure and no change in clinical status (n = 74, 10.3%). In conclusion, the appropriateness criteria for echocardiography were easily applied to real-world patients. Most patients in our series had undergone TTE for an appropriate indication.