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Appropriateness of referrals for single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in a developing community: A comparison between 2005 and 2009 versions of ACCF/ASNC appropriateness criteria

Gholamrezanezhad, A. and Shirafkan, A. and Mirpour, S. and Rayatnavaz, M. and Alborzi, A. and Mogharrabi, M. and Hassanpour, S. and Ramezani, M. (2011) Appropriateness of referrals for single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in a developing community: A comparison between 2005 and 2009 versions of ACCF/ASNC appropriateness criteria. Journal of Nuclear Cardiology, 18 (6). pp. 1044-1052. ISSN 10713581 (ISSN)

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Abstract

Appropriateness of referrals for myocardial perfusion imaging (MPI) in developing countries has not been extensively studied. Our study was conducted to describe the ordering practices of physicians and appropriateness of MPI referrals in Iran. We prospectively applied 2005 and 2009 versions of the Appropriateness Use Criteria published by the American College of Cardiology Foundation (ACCF) and the American Society of Nuclear Cardiology (ASNC) to 291 consecutive patients (age 55.3 ± 10.3 years) who underwent SPECT-MPI. For this purpose, we convened a panel, consisting of two academic cardiologists, one academic clinician in internal medicine, and one academic clinician in nuclear medicine. The panelists were invited for a face-to-face meeting to judge appropriateness of SPECT-MPI and independently assign a specific indication (scenario), whenever possible, for each case in accordance with ACCF/ASNC appropriateness scenarios. Based on the 2005 ACCF/ASNC criteria, SPECT-MPI studies were judged appropriate for 211 (72.5%), uncertain for 36 (12.4%), inappropriate for 32 (11.0%), and unclassifiable for 12 (4.1%) referrals. The same figures based on the 2009 version were 219 (75.3%), 15 (5.2%), 49 (16.8%), and 8 (2.7%) patients, respectively. Overall agreement between the 2005 and 2009 versions was good (κ 0.63). Lack of chest pain and age below 60 years were significant indicators increasing the likelihood of inappropriate referrals by 2.9-3.4 fold. Absence of diabetes mellitus and hypertension, a normal lipid profile, lack of a past history of myocardial infarction or cardiovascular interventions (CABGs or PCI), as well as lack of application and exercise ECG stress test as the gate keeper (keeping abnormal ETT or inability of the patient to perform exercise as the appropriate indication for SPECT-MPI referral) were significant indicators, decreasing the odds of appropriate referrals. Generally a higher percentage of referrals with inappropriate indications had normal MPI. Our study provides an evidence for the fact that SPECT-MPI ordering practices in our developing community largely parallel the ACCF/ASNC recommendations. The implementation of appropriateness criteria is feasible in clinical settings and might provide an alternative to utilization management. © 2011 American Society of Nuclear Cardiology.

Item Type: Article
Additional Information: Unmapped bibliographic data: LA - English [Field not mapped to EPrints] J2 - J. Nucl. Cardiol. [Field not mapped to EPrints] C2 - 21818700 [Field not mapped to EPrints] AD - Research Institute for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran [Field not mapped to EPrints] AD - Golestan Cardiovascular Research Center, 5th Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran [Field not mapped to EPrints] AD - Department of Internal Medicine, 5th Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran [Field not mapped to EPrints] AD - Department of Nuclear Medicine, 5th Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran [Field not mapped to EPrints] AD - Department of Cardiology, 5th Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran [Field not mapped to EPrints] DB - Scopus [Field not mapped to EPrints]
Uncontrolled Keywords: Appropriateness criteria, guidelines, myocardial perfusion imaging, adult, article, clinical decision making, clinical indicator, clinical practice, controlled study, coronary artery bypass graft, developing country, diabetes mellitus, exercise electrocardiography, exercise test, feasibility study, female, heart infarction, human, hypertension, Iran, lipid analysis, major clinical study, male, medical history, myocardial perfusion imaging, patient assessment, patient referral, percutaneous coronary intervention, physician attitude, practice guideline, priority journal, prospective study, risk factor, single photon emission computer tomography, thorax pain, Adult, Aged, Aged, 80 and over, Cardiovascular Diseases, Developing Countries, Female, Health Services Misuse, Humans, Iran, Male, Middle Aged, Myocardial Perfusion Imaging, Prevalence, Referral and Consultation, Reproducibility of Results, Risk Assessment, Risk Factors, Sensitivity and Specificity, Tomography, Emission-Computed, Single-Photon
Subjects: مقالات نمایه شده محققین دانشگاه در سایت ,Web of Science ,Scopus
موارد کلی
Divisions: معاونت تحقیقات و فناوری
Depositing User: GOUMS
Date Deposited: 19 Apr 2015 04:47
Last Modified: 14 May 2015 04:21
URI: http://eprints.goums.ac.ir/id/eprint/2067

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