Abstract
Introduction: Considering the increased expenditure in public health sector, especially the increased cost in hospitals and clinics, there is an urgent need to control these costs mainly by ensuring adherence to clinical guidelines for diagnostic procedures. In this study we aim to investigate the adherence of heart clinics to guideline for exercise tolerance test. Methods: This cross-sectional study was performed on 308 patients who were referred for ECG exercise test in 3 clinics located in the city of Shiraz, Iran in 2018. Demographic and clinical data were recorded and the indications of exercise test for each patient was reviewed according to the ACC/AHA guideline for exercise tolerance test. Results: Exercise tests were found to be inappropriately done in 121 (39.3%) participants. Among the patients for whom the test was done without indication 79 (65.3%) were women and the gender difference was statistically significant (P < 0.01); women were 18.5% more likely to undergo exercise test without indication. There was more inappropriate tests among nonanginal pain subsets comparing to other presenting symptoms (P < 0.001). Age, coronary risk factors, reason for performing exercise tests and private health system were not predictors of inappropriate use (P > 0.05). Conclusion: This study confirms that more than one third of exercise tests done in the participants are inappropriate. Wide availability of exercise test makes it vulnerable to overuse and additional unnecessary cost to health care systems.
Highlights
Considering the increased expenditure in public health sector, especially the increased cost in hospitals and clinics, there is an urgent need to control these costs mainly by ensuring adherence to clinical guidelines for diagnostic procedures
According to our final assessment, out of the 308 participants, 187 cases underwent an exercise test according to the guidelines (60.7%) and 121 participants (39.3%) underwent exercise test without guideline indications
Among the tests done without indication, 79 (65.3%) were women and 42 (34.7%) were men and the gender difference was statistically significant (P < 0.01); women were 18.5% more likely to undergo an exercise test without indication
Summary
Considering the increased expenditure in public health sector, especially the increased cost in hospitals and clinics, there is an urgent need to control these costs mainly by ensuring adherence to clinical guidelines for diagnostic procedures. According to World Health Organization reports, the costs of public health in hospitals and clinics has increased in most countries and is a burden on the public sector, which threatens the overall integrity of the system.[1] Management of the current resources without increasing the expenses is a great challenge which affects patients and health managers .[2] This is of special concern in developing countries where already strained resources are increasingly being directed toward health sector.[3,4] There are several solutions to this increased expenditure, including constant surveillance, establishment of a robust referral system and adherence to clinical guidelines established at international, national and institutional levels.[4,5,6] As mentioned earlier, ensuring adherence to clinical guidelines is one method of controlling the spiraling health expenditure This can be true in the management of chronic diseases which are considered one of the most draining subjects of health budgets.[7] Among chronic diseases, coronary artery disease is the leading cause of death worldwide, and annual direct and indirect cost of cardiovascular disease in the United states of America is estimated to be around $350 billion,[8] and Iran ranks 25 in the mortality rate of coronary
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
