Superficial analysis or inappropriate indications for echocardiography?

LETTER TO THE EDITOR

Superficial analysis or inappropriate indications for echocardiography?

Marco Tulio Zanettini; João Otavio Zanettini; Jacira Pisani Zanettini

Eletrocor Laboratório Cárdio-Diagnóstico, Caxias do Sul, RS - Brazil

^{Mailing Address}

Keywords: Echocardiography/Standards; Echocardiography/utilization; Guidelines/Standards; Guidelines/utilization.

Dear editor,

We would like to make some considerations about the Brief Communication Inadequate Request of Transthoracic Echocardiography.

Guidelines², extremely valuable tools for medical practice, should be used according to critical thinking and adapted to real world patients. Individuals at increased risk, if neglected, are exposed to social and economic costs much higher than those of any diagnostic investigation.

The medical ethics code³ forbids physicians to disclose confidential data of their patients without consent. Thus, a simplistic analysis of test request forms is definitely inappropriate.

We consider of fundamental importance to analyze the incidence of echocardiographic abnormalities detected in patients whose indications to undergo that test were considered inappropriate¹, in order to evaluate de actual accuracy and validity of each indication.

Finally, data that are superficially analyzed and presented might expose physicians even more to the increasing restriction of their activities and to legal traps.

Echocardiography/Standards; Echocardiography/utilization; Guidelines/Standards; Guidelines/utilization.

Manuscript received October 15, 2012; revised manuscript December 13, 2012, accepted December 13, 2012.

Replay

We thank the opportunity to respond to the considerations regarding our article titled Inadequate Request of Transthoracic Echocardiography. Please, find our comments below.

1. Medical societies worldwide have striven to improve the quality of medical testing. The initiatives of the American College of Cardiology, via the Imaging in FOCUS and Appropriate Use Criteria for Echocardiography², and of the Radiology Society of North America, via Image Wisely³, are remarkable. The search for quality is essential in the asymmetric world we live in, where patients from the public health care system wait months for tests, such as echocardiographies, scans and tomographies.

2. At the Universidade Federal Fluminense, we coordinate a research line about quality in imaging tests, which comprises the study of the best indications for the tests. We were the first to publish studies about the use of appropriateness criteria for echocardiography in Brazil⁴ and the comparison of such criteria between the private and public health care systems⁵. Appropriateness criteria are extremely valuable tools for medical practice, allow improvement of quality, and are used by an increasing number of medical societies.

3. Our study was approved by the Committee on Ethics and Research, as reported in the article, and the indication for the test by the requesting physician was analyzed in an interview with the patient by the echocardiographer FCPB, who performed all the tests of the study⁵. Data were extensively analyzed, and the requesting physicians were contacted to clarify doubts, whenever possible. Describing the findings of the tests was not within the scope of the study.

4. Cardiology must lead the movement for quality. Knowing that of every 100 echocardiograms 8 are grade III indications of the Brazilian Guidelines for Echocardiography is important, because we can better manage access to the test, allowing patients with more solid indications to have priority access, improving test availability for users in need of it.

Sincerely,

Laiz Boniziolli Barachi

Flávia Candolo Pupo Barbosa

Samuel-Datum Moscavitch

Bárbara Contarato Pilon

Gabriela Vescovi Pissinati

Evandro Tinoco Mesquita

Cláudio Tinoco Mesquita

Marcus Vinicius Santos

References

Referências (Resposta)

• 1. Barachi LB, Barbosa FCP, Moscavitch S-D, Pilon BC, Pissinati GV, Mesquita CT, et al. Uso inapropriado da ecocardiografia transtorácica segundo recomendações da SBC. Arq Bras Cardiol.2012;99(4):960-3.
• 2. Barbosa MM, Nunes MCP, Campos Filho O, Camarozano A, Rabischoffsky A, Maciel BC, et al. Sociedade Brasileira de Cardiologia. Diretrizes das indicações da ecocardiografia. Arq Bras Cardiol.2009;93(6 supl.3):e265-e302.
• ³
  Conselho Federal De Medicina. (CFM). Código de Ética Médica.Resolução CFM n.1931, de 17 de setembro de 2009. [Acesso em 2012 out 25]. Disponível em: http://www.portalmedico.org.br/resoluções/CFM/2009/1931_2009.htm
• 1. Barachi LB, Barbosa FCP, Moscavitch S-D, Pilon BC, Pissinati GV, Mesquita CT et aL. Uso inapropriado da ecocardiografia transtorácica segundo recomendações da SBC. Arq Bras Cardiol.2012;99(4):960-3.
• 2. Douglas PS, Garcia MJ, Haines DE, Lai WW, Manning WJ, Patel AR, et al. ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance American College of Chest Physicians. J Am Soc Echocardiogr.2011;24(3):229-67.
• 3. Brink JA, Amis ES Jr. Image Wisely: a campaign to increase awareness about adult radiation protection. Radiology. 2010;257(3):601-2.
• 4. Barbosa F,Mesquita ET, Salgado A, Mesquita CT. Qualidade em cardioimagem: critérios de appropriateness aplicados à ecocardiografia. Rev Bras Cardiol.2010;23(2):185-96.
• 5. Barbosa FC, Mesquita ET, Barachi LB, Salgado A, Kazuo R, Rosa ML, Mesquita CT. Comparação da adequação de solicitação de ecocardiograma entre hospital público e privado. Arq Bras Cardiol.2011;97(4):281-8.

Publication Dates

• Publication in this collection
  11 Mar 2013
• Date of issue
  Feb 2013