Original Title: Guides et normes: Usage optimal de l’échographie cardiaque au Québec dans le contexte de l’insuffisance cardiaque chronique

Authors' objectives: Seeking to improve access to diagnostic examinations and their appropriate use, the Ministère de la Santé et des Services sociaux (MSSS) has asked the Institut national d'excellence en santé et en services sociaux (INESSS) to produce guidance documents with indications for clinical situations where diagnostic imaging is used frequently and is costly, and for which the rate of inappropriate examinations is likely to be high. Echocardiography is one of the examinations whose use could be optimized. Echocardiography (or cardiac ultrasound) is an important noninvasive imaging technique for diagnosing, managing and follow-up of multiple cardiovascular conditions. In Québec, the number of billed transthoracic echocardiograms (TTEs) increased from 219,369 in 2009 to 314,662 in 2018, for an average annual increase of approximately 4%. This report focuses on the use of echocardiography to diagnose and monitor chronic heart failure.

Authors' results and conclusions: RESULTS: Eighteen practice guidelines and 7 reviews were selected: • These materials were from Canada, the United States, European countries and Australia/New Zealand. • The selected guidelines primarily address two categories of topics: – The diagnosis and/or management of heart failure in general; – The appropriate use of echocardiography in heart failure and other conditions. • Items for assessing health status were suggested: – Assessment of the individual’s history, symptoms and signs; – Diagnosis test options: BNP/NT-proBNP measurement as a discriminating test in patients with low suspicion of heart failure. • Seven indications/contraindications were defined: – Three indications and contraindications concerning the use of TTE to diagnose heart failure; – Four indications and contraindications concerning the use of TTE to monitor a heart failure patient. CONCLUSION: At the end of the work presented in this report, the indications/contraindications and the decision support tool developed have the potential to lead to the optimal use of echocardiography, to help reduce its inappropriate use and thus to improve its accessibility in Québec.

Authors' methods: A methodology involving a rapid review of the scientific and grey literature was used to identify the recommendations and indications for the use of echocardiography to diagnose and monitor chronic heart failure. • The identified guidelines were evaluated using the AGREE II tool, and the quality of reviews was assessed using the AMSTAR-2 tool. • The extraction and analysis of the relevant data led to the drawing up of indications/counterindications, which were subsequently validated by consensus of experts − clinicians − from various practice settings in Québec’s healthcare system. • A clinical decision support tool that can be used during medical visits was developed to synthesize the clinical indications.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/en/publications/publications/publication/usage-optimal-de-lechographie-cardiaque-au-quebec.html

Year Published: 2023

URL for published report: https://www.inesss.qc.ca/en/publications/publications/publication/usage-optimal-de-lechographie-cardiaque-au-quebec.html

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

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