Prescriptive Appropriateness in an Outpatient Primary and Secondary Cardiovascular Prevention Service

Introduction: In the absence of appropriateness specific guidelines, one important cause of health resources waste could be overuse of diagnostic procedures. Since arterial hypertension is a very frequent disease there could be such a risk in its management.

Aim: To evaluate the prescriptive appropriateness of non-invasive diagnostic tests (echocardiography, carotid ultrasound, ECG exercise test, 24 h Ambulatory Blood Pressure Monitoring-ABPM) in a primary and secondary prevention outpatient's service.

Methods: 559 outpatients visits were retrospectively analysed and appropriateness of every prescription was evaluated. An integration of different Italian and European guidelines was used to define appropriateness.

Results: 449 prescriptions were made (198 echocardiography, 148 carotid ultrasound, 85 24 h ABPM and 18 ECG exercise testing). General appropriate prescriptions prevalence was 40.3%, 24 h ABPM being the most appropriate one (49.4%) followed by echocardiography (43.9%), ECG exercise test, (38.9%) and carotid ultrasound (30.4%). Appropriateness was significantly higher for secondary prevention patients (61.6 vs. 35.3%, p < 0.001) particularly for heart and carotid ultrasound. Significant univariate correlations were identified between age, cardiovascular risk category, degree of prevention (primary vs. secondary), duration of hypertension and the presence of valvular heart disease and prescription appropriateness. However, at multivariate analysis these findings were not confirmed.

Conclusions: Our study shows a relevant percentage of inappropriate prescriptions of non-invasive cardiologic exams particularly in the primary prevention setting.