Transthoracic Echocardiography: Use in Austria and Guideline recommendations for appropriate use

Research areas: High tech medicine, Health economics, HTA-methods & steering instruments

Duration: May 2017 – November 2017
On behalf of the Main Association of Austrian Social Insurance Institutions

Publikation: LBI-HTA Projektbericht Nr. 98: http://eprints.hta.lbg.ac.at/1158/

Language: German (with english summary)

Background:
The transthoracic echocardiography is an ultrasound based examination of the heart. Due to the fact that transthoracic echocardiography is painless and witht no side effects, this examination is used frequently. However, like every other examination, the transthoracic echocardiography can lead to false positive results and overdiagnosis. These are associated with further examinations, and potentially unnecessary treatments that pose a health risk patients.

Aim of the project:
The aim of this project is to show for which indications the transthoracic echocardiography is considered to be appropriate. In addition, the use of this examination in Austria will be presented.

Research questions:

1. What are the differences between the Austrian guideline recommendations on appropriate use of transthoracic echocardiography and international recommendations?
2. What methods to assess the appropriateness of transthoracic echocardiography are in use?
3. What is the geographic variation in the use of transthoracic echocardiography in Austria?
4. Are there signs of inappropriate use of transthoracic echocardiography in Austria?
5. How is the use of transthoracic echocardiography related to other examinations, interventions or other variables like ECG, ergometry, coronary heart diseases, or drug use?

Methods:

1. Presenting and discussing the guideline recommendations of different organizations (Orientierungshilfe Radiologie; Deutsche Gesellschaft für Kardiologie; American College of Radiology; American College of Cardiology).
2. Hand search for studies that measured the appropriateness in the use of transthoracic echocardiography.
3. Presentation of the geographic variation in the use of transthoracic echocardiography in Austria by the use of age and sex standardized data.
4. Depending on data availability and the results of research questions 1-2: Development of hypotheses on the basis of the extracted recommendations on the (in)appropriate use of transthoracic echocardiography. These hypotheses will further be assessed by the use of health care data.
5. Depending on data availability: Presentation of the relationship between the use of transthoracic echocardiography and ECG, ergometry, coronary heart diseases and associated drug use.

Time schedule:

Time frame	Tasks
May to June 2017	Extraction und discussion of guideline recommendations
June to July 2017	Search for methods to measure the appropriateness transthoracic echocardiography Development of hypotheses for he estimation of the appropriateness of transthoracic echocardiography
August bis September 2017	Data retrieval and data analysis Presentation of geographic variation
September bis Oktober 2017	Drafting of the report  External review
November 2017	Revision and finalisation of the report