Abstract
BackgroundIn some countries, the public health system has less availability when compared to the population covered by health insurance. In addition, inappropriate referrals for treadmill exercise stress test increase spending and lead to unnecessary interventions. We aim to determine the prevalence and characteristics of inappropriate referrals for treadmill exercise stress tests in the assessment of coronary artery disease (CAD), considering public and private health systems scenarios.MethodsA cross-sectional design was used to describe the frequency of inappropriate use of exercise testing in the diagnosis of CAD and to determine its predictors. We consecutively enrolled 191 patients from two outpatient facilities in Northeast Brazil. For inclusion, the exercise testing should be referred for the assessment of CAD. We performed logistic regression models to identify independent predictors of inappropriate use.ResultsTreadmill exercise stress tests were rated as inappropriate in 150 (78 %) patients. The majority of patients had low or very low pre-test probability of CAD. Presence of hypertension, diabetes and dyslipidemia were more frequent in the appropriate than inappropriate indications (71 %, 19 % and 29 % versus 43 %, 8 % and 16 %, respectively). Tests performed both at the public and private system showed high prevalence of inappropriate examinations, higher in the latter (57 % versus 87 %, P < 0.001). The private health system was the major independent predictor of inappropriate referral, consistent in all regression models (when adjusting for clinical variables, OR = 4.3; P < 0.001).ConclusionThe vast majority of treadmill exercise stress test referrals in the assessment of CAD were inappropriate. The availability of the method and not the estimate probability of CAD appear to be the underlying condition for a treadmill test referral.
Highlights
In some countries, the public health system has less availability when compared to the population covered by health insurance
There was a predominance of subjects with pre-test probability for coronary heart disease low or very low (29 % and 44 %, respectively) and low cardiovascular risk (80 %), according to the World Health Organization (WHO) risk prediction
In a developing country, we describe the prevalence of inappropriate use of treadmill exercise stress tests for the diagnosis of coronary artery disease (CAD) in public and private health
Summary
The public health system has less availability when compared to the population covered by health insurance. Inappropriate referrals for treadmill exercise stress test increase spending and lead to unnecessary interventions. We aim to determine the prevalence and characteristics of inappropriate referrals for treadmill exercise stress tests in the assessment of coronary artery disease (CAD), considering public and private health systems scenarios. The treadmill exercise stress test appears to be vulnerable to overuse in clinical settings, due to its wide availability and affordability. The inappropriate use of the method, Developing countries in which private and public health systems coexist have limited funding for health. In developed countries that have universal health care systems such as France and Germany, investment in health was about five times higher [4].
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