ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography

Pamela S. Douglas, Mario J. Garcia, David E. Haines, Wyman W. Lai, Warren J. Manning, Ayan R. Patel, Michael H. Picard, Donna M. Polk, Michael Ragosta, R. Parker Ward, Rory B. Weiner, Steven R. Bailey, Peter Alagona, Jeffrey L. Anderson, Jeanne M. DeCara, Rowena J. Dolor, Reza Fazel, John A. Gillespie, Paul A. Heidenreich, Luci K. LeykumJoseph E. Marine, Gregory J. Mishkel, Patricia A. Pellikka, Gilbert L. Raff, Krishnaswami Vijayaraghavan, Neil J. Weissman, Katherine C. Wu, Michael J. Wolk, Robert C. Hendel, Christopher M. Kramer, James K. Min, Manesh R. Patel, Leslee Shaw, Raymond F. Stainback, Joseph M. Allen

Research output: Contribution to journalReview articlepeer-review

442 Scopus citations


The American College of Cardiology Foundation (ACCF), in partnership with the American Society of Echocardiography (ASE) and along with key specialty and subspecialty societies, conducted a review of common clinical scenarios where echocardiography is frequently considered. This document combines and updates the original transthoracic and transesophageal echocardiography appropriateness criteria published in 2007 (1) and the original stress echocardiography appropriateness criteria published in 2008 (2). This revision reflects new clinical data, reflects changes in test utilization patterns, and clarifies echocardiography use where omissions or lack of clarity existed in the original criteria. The indications (clinical scenarios) were derived from common applications or anticipated uses, as well as from current clinical practice guidelines and results of studies examining the implementation of the original appropriate use criteria (AUC). The 202 indications in this document were developed by a diverse writing group and scored by a separate independent technical panel on a scale of 1 to 9, to designate appropriate use (median 7 to 9), uncertain use (median 4 to 6), and inappropriate use (median 1 to 3). Ninety-seven indications were rated as appropriate, 34 were rated as uncertain, and 71 were rated as inappropriate. In general, the use of echocardiography for initial diagnosis when there is a change in clinical status or when the results of the echocardiogram are anticipated to change patient management were rated appropriate. Routine testing when there was no change in clinical status or when results of testing were unlikely to modify management were more likely to be inappropriate than appropriate/uncertain. The AUC for echocardiography have the potential to impact physician decision making, healthcare delivery, and reimbursement policy. Furthermore, recognition of uncertain clinical scenarios facilitates identification of areas that would benefit from future research.

Original languageEnglish (US)
Pages (from-to)1126-1166
Number of pages41
JournalJournal of the American College of Cardiology
Issue number9
StatePublished - Mar 1 2011
Externally publishedYes


  • ACCF Appropriate Use Criteria
  • cardiac imaging
  • coronary artery disease
  • diagnostic testing
  • echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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