[Guides and standards: optimal use of cardiac ultrasound in Québec - diagnosing patients with a murmur and monitoring patients with valve diseases (native and prosthetic valves)]
Robitaille H, Parent M
Record ID 32018002351
French
Original Title:
Guides et normes: Usage optimal de l’échographie cardiaque au Québec : diagnostic des patients qui présentent un souffle et suivi des patients atteints d’une maladie valvulaire (valves natives et valves prothétiques)
Authors' objectives:
In an effort to improve access to diagnostic examinations and the appropriateness of their use, the Ministère de la Santé et des Services sociaux (MSSS) asked the Institut national d'excellence en santé et en services sociaux (INESSS) to produce reports/guidelines with recommendations/indications concerning clinical situations where diagnostic imaging is frequently used and costly, and where the number of inappropriate examinations is probably high. Echocardiography is one of the examinations whose use could be optimized. The purpose of this guideline is to support clinicians, especially primary care providers, in deciding whether or not to use echocardiography to diagnose and monitor valvular heart disease in patients with a murmur or a known valve disease, or in patients with a prosthetic heart valve. Indications for optimal use were developed on the basis of the best scientific evidence and an expert consensus. The appropriateness indications presented in this guideline are supplemented by clinical decision support tools.
The clinical indications proposed in this document concern only the echocardiographic diagnosis and monitoring of valve diseases in adult patients. The other aspects of management, including treatment and clinical follow-up, are not discussed.
Authors' results and conclusions:
RESULTS: Fifteen guidelines from the United States, Europe and the United Kingdom were used for a comparative analysis of recommendations/indications. In addition, 16 reviews providing clarification of the evidence were found. Clinical indications for guiding the use of echocardiography to diagnose valvular heart disease or that report frequencies of use of echocardiography for monitoring patients with known valve disease or with a prosthetic valve were selected. The expert committee’s members helped validate the indications, particularly in cases where evidence was not available or if there was no consensus in the literature.
A total of 51 clinical indications and contraindications are proposed and are grouped into three clinical contexts, namely:
• Indications and contraindications for the use of echocardiography to evaluate patients with a murmur;
• Indications and contraindications for the use of echocardiography to monitor patients with a valve disease (native valves);
• Indications and contraindications for the use of echocardiography to monitor patients who have undergone a valve repair or who have a prosthetic valve.
These indications are presented in the clinical decision support tools and are summarized in a document available on INESSS’s website.
CONCLUSION: The proposed indications and contraindications have the potential to increase the appropriate use of echocardiography to diagnose and monitor valve diseases, which accounts for a considerable proportion of the echocardiograms performed in Québec. Reducing the number of investigations with low diagnostic value could lead to better access to echocardiography, an improvement in the patients’ quality of life, and, ultimately, cost reductions for the health-care system.
Decision support tools have been developed to facilitate the implementation of the indications.
Authors' methods:
The purpose of this guideline is to support clinicians, especially primary care providers, in deciding whether or not to use echocardiography to diagnose and monitor valvular heart disease in patients with a murmur or a known valve disease, or in patients with a prosthetic heart valve. Indications for optimal use were developed on the basis of the best scientific evidence and an expert consensus. The appropriateness indications presented in this guideline are supplemented by clinical decision support tools.
The clinical indications proposed in this document concern only the echocardiographic diagnosis and monitoring of valve diseases in adult patients. The other aspects of management, including treatment and clinical follow-up, are not discussed.
Details
Project Status:
Completed
Year Published:
2022
English language abstract:
An English language summary is available
Publication Type:
Other
Country:
Canada
Province:
Quebec
MeSH Terms
- Heart Diseases
- Echocardiography
- Aortic Valve Disease
- Pulmonary Valve Stenosis
- Mitral Valve Insufficiency
- Heart Valve Prosthesis
- Heart Defects, Congenital
- Heart Murmurs
Contact
Organisation Name:
Institut national d'excellence en sante et en services sociaux
Contact Address:
L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369
Contact Name:
demande@inesss.qc.ca
Contact Email:
demande@inesss.qc.ca
Copyright:
Gouvernement du Québec
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.