SynthesisPloS one2016
Appropriate Use of Cardiac Stress Testing with Imaging: A Systematic Review and Meta-Analysis.
Synthesis in PloS one, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Society for Cardiovascular Magnetic Resonance recommendations toward environmentally sustainable cardiovascular magnetic resonance.Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance · 2025Guideline
- Evaluating Blood Pressure Response Patterns to Exercise Stress Testing.Hypertension (Dallas, Tex. : 1979) · 2025Article
- Quality metrics for single-photon emission computed tomography myocardial perfusion imaging: an ASNC information statement.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2023Review
- Insights into Nuclear Cardiology in the United States from the first 3 years of the ImageGuide Registry.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2022Article
- Appropriate use criteria implementation with modified Haller index for predicting stress echocardiographic results and outcome in a population of patients with suspected coronary artery disease.The international journal of cardiovascular imaging · 2021Article
- Appropriateness of inpatient stress testing: Implications for development of clinical decision support mechanisms and future criteria.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2021Article
- Ten things to know about ten imaging studies: A preventive cardiology perspective ("ASPC top ten imaging").American journal of preventive cardiology · 2021Review
- Differences in High- and Low-Value Cardiovascular Testing by Health Insurance Provider.Journal of the American Heart Association · 2021Article
- E-Consult Protocoling to Improve the Quality of Cardiac Stress Tests.JACC. Cardiovascular imaging · 2021Article
- Trends in High- and Low-Value Cardiovascular Diagnostic Testing in Fee-for-Service Medicare, 2000-2016.JAMA network open · 2019Article
- Facility-Level Variation in Stress Test Utilization in Veterans With Ischemic Heart Disease.JACC. Cardiovascular imaging · 2019Article
- Prevalence and clinical characteristics of inappropriate myocardial perfusion imaging tests at a community hospital.BMJ open quality · 2019Article
- Application of exercise ECG stress test in the current high cost modern-era healthcare system.Indian heart journalReview
- Article
- Appropriate use criteria in myocardial perfusion imaging in a tertiary care hospital in South India: An audit.World journal of nuclear medicineArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
Abstract
backgroundAppropriate use criteria (AUC) for cardiac stress tests address concerns about utilization growth and patient safety. We systematically reviewed studies of appropriateness, including within physician specialties; evaluated trends over time and in response to AUC updates; and characterized leading indications for inappropriate/rarely appropriate testing.
methodsWe searched PubMed (2005-2015) for English-language articles reporting stress echocardiography or myocardial perfusion imaging (MPI) appropriateness. Data were pooled using random-effects meta-analysis and meta-regression.
resultsThirty-four publications of 41,578 patients were included, primarily from academic centers. Stress echocardiography appropriate testing rates were 53.0% (95% CI, 45.3%-60.7%) and 50.9% (42.6%-59.2%) and inappropriate/rarely appropriate rates were 19.1% (11.4%-26.8%) and 28.4% (23.9%-32.8%) using 2008 and 2011 AUC, respectively. Stress MPI appropriate testing rates were 71.1% (64.5%-77.7%) and 72.0% (67.6%-76.3%) and inappropriate/rarely appropriate rates were 10.7% (7.2%-14.2%) and 15.7% (12.4%-19.1%) using 2005 and 2009 AUC, respectively. There was no significant temporal trend toward rising rates of appropriateness for stress echocardiography or MPI. Unclassified stress echocardiograms fell by 79% (p = 0.04) with updated AUC. There were no differences between cardiac specialists and internists.
conclusionsRates of appropriate use tend to be lower for stress echocardiography compared to MPI, and updated AUC reduced unclassified stress echocardiograms. There is no conclusive evidence that AUC improved appropriate use over time. Further research is needed to determine if integration of appropriateness guidelines in academic and community settings is an effective approach to optimizing inappropriate/rarely appropriate use of stress testing and its associated costs and patient harms.
Indexed as
Identifiers
What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.