Comparison of the 2008 and 2011 Appropriate Use Criteria for Stress Echocardiography

Background: The 2008 appropriate use criteria (AUC) for stress echocardiographic (SE) examinations were revised in 2011 to cover a wider range of scenarios of use. Data comparing the 2008 and 2011 AUC for SE are limited. Methods: A retrospective chart review of SE studies performed at an academic medical center was conducted, and ordering of SE studies was assessed using the 2008 and 2011 AUC. Results: A total of 252 consecutive SE studies performed in 2011 were reviewed. The 2008 AUC classified 126 SE studies (50%), and the 2011 AUC classified 221 SE studies (88%) (P < .001). Of all SE studies, 106 (42%) were performed as part of evaluations for noncardiac solid-organ transplantation. The majority of these studies (79%) were classified as inappropriate using the 2011 AUC and were not classifiable using the 2008 AUC. Of the 146 SE studies performed for other reasons, 69% were appropriate and 22% were inappropriate using the 2011 AUC. Inappropriate SE studies for both the general nontransplant and noncardiac solid-organ transplantation populations were nearly exclusively ordered for perioperative assessment with normal functional capacity. The SE studies that remained unclassified by the 2011 AUC were related to the assessment of specialized cardiac conditions, including hypertrophic cardiomyopathy and follow-up after heart transplantation. Conclusions: The 2011 AUC classify a significantly greater proportion of SE studies compared with the 2008 AUC. Most of the reclassified SE studies using the 2011 AUC were inappropriate and were ordered for perioperative assessments in patients with normal functional capacity. (J Am Soc Echocardiogr 2013;26:339-43.)