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Groups Urge Caution on 45 Standards of Care

Cheryl Clark, for HealthLeaders Media, April 5, 2012

American College of Cardiology
11. Don't perform stress cardiac imaging or advanced non-invasive imaging in the initial evaluation of patients without cardiac symptoms unless high-risk markers are present. Low-risk patients account for 45% of unnecessary "screening." Testing should occur only in the presence of diabetes in patients older than 40, peripheral artery disease or greater than 2% yearly risk for coronary artery disease patients.

12. Don't perform annual stress cardiac imaging or advanced non-invasive imaging as follow-up in asymptomatic patients. This rarely results in any meaningful course of care but may lead to unnecessary invasive procedures and excess radiation exposure. Patients' five years post bypass surgery are an exception.

13. Don't perform stress cardiac imaging or advanced non-invasive imaging as a pre-operative assessment in patients scheduled to undergo low-risk non-cardiac surgery. Non-invasive testing is not useful for patients with low-risk, non-cardiac surgery such as cataract removal.

14. Don't perform echocardiography as routine follow-up for mild, asymptomatic native valve disease in adults with no change in symptoms.

15. Don't perform stenting of non-culprit lesions during percutaneous coronary intervention for uncomplicated hemodynamically stable ST-segment elevation myocardial infarction. This could increase mortality and complications, although may be beneficial in patients who are hemodynamically unstable.

American College of Physicians
16. Don't obtain screening exercise electrocardiogram testing in individuals who are asymptomatic and at low risk for coronary heart disease. It does not improve outcomes.

17. Don't obtain imaging studies with non-specific low back pain. Plain radiography, CT or magnetic resonance imaging does not improve outcomes.

18. In the evaluation of simple syncope and a normal neurological exam, don't obtain brain imaging studies with CT or MRI. The likelihood of central nervous system cause is extremely low and these tests do not improve patient outcomes.

19. In patients with low pretest probability of venous thromboembolism, obtain a high sensitive D-dimer measurement as the initial diagnostic test; don't obtain imaging studies as the initial diagnostic test.

20. Don't obtain preoperative chest radiography in the absence of suspicion for intrathoracic pathology or cardiopulmonary symptoms.

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