Part 2: Echocardiography and Stress Testing--Which is Appropriate for You?
In this article, I will discuss how cardiologists determine the appropriateness of a stress test or echocardiogram for their patients.
Although the use of testing is simple and intuitive for your clinician, confusion arises because private insurance carriers and even Medicare create different criteria for determining the appropriateness of a test.
In addition to using their experience and clinical judgement, cardiologists refer to published expert consensus guidelines known as ‘Appropriate Use Criteria’ or AUC guidelines in determining which cardiac tests are appropriate for their patients.
The AUC guidelines are created by leading experts in multiple disciplines (medical societies) who review the existing literature and judge the appropriateness of a cardiac test in various scenarios.
The AUC guidelines generally have 3 levels of appropriateness for any particular diagnostic or therapeutic procedure:
1. Appropriate—in which the use of testing is supported by data,
2. May be Appropriate—where data may be lacking and use of testing is at the discretion of the clinician,
3. Inappropriate—data does not support the use of testing.
In general, inappropriate testing is to be avoided. However, the AUC guidelines also defer responsibility to the treating physician. This is because the AUC guidelines do not necessarily represent the standard-of-care, but are only intended to be guidance for both clinicians and insurance carriers. For example, a test which is considered ‘inappropriate’ by AUC guidelines for the public may well be appropriate for the individual patient. In other words, if a patient suffers and adverse outcome because a physician claims the test or procedure was 'inappropriate' by AUC guidelines, the physician is still potentially liable for malpractice.
I hope this article helps you understand how cardiologists determine which studies are right for their patients.
For more information, I suggest you read the Appropriate Use Criteria.
Gregg M. Yamada MD FACC