There is some controversy about the utilization of non-invasive cardiac diagnostic procedures. This debate refers to the issue of whether or not the test was actually indicated. In Ontario, Canada, any Physician can refer to any non-invasive cardiac diagnostic facility whether that facility be Hospital based or non-Hospital based. The Kingston Heart Clinic (KHC) is an Outpatient non-invasive cardiac diagnostic facility. A comprehensive clinical cardiology database, CARDIOfile has been developed and is utilized for all aspects of clinical and investigative Cardiology. CARDIOfile has been designed to conform to the published ACC/AHA guidelines for the indication(s) for all forms of cardiac testing. All CARDIOfile data is entered prospectively. CARDIOfile has been used at KHC since May 1999.

OBJECTIVE: To address the issue of appropriateness of the indication with published ACC/AHA guidelines for Exercise testing (ET) and Echocardiography (ECHO) of Patients referred to KHC by Family Doctors.

METHODS: We have restricted the data collection to the last 2000 consecutive tests performed at KHC for each of these procedures. Patients who were referred by Specialists were excluded. This left 1672 ET and 1329 ECHOs for analysis and represents a timeframe where the database has not undergone any substantial changes, thus representing stable data collection. We felt this restriction was necessary as during the early years there were substantial changes during database development.

RESULTS: See table.

CONCLUSIONS: This analysis reveals that our Family Doctors are referring Patients for ET and ECHO with a high degree of appropriateness. 96.4% of Exercise tests and 99.1% of Echocardiograms have an appropriate ACC/AHA I-IIb indication. Even if one only includes ACC/AHA class I and IIa indications, then there is still a high of appropriateness of 83.7% for ET and 98.7% for ECHO.

DC

NEXT