Appendix C. Detail on criteria for audit of the use of myocardial perfusion scintigraphy for the diagnosis and management of angina and myocardial infarction

Appendix C. Detail on criteria for audit of the use of myocardial perfusion scintigraphy for the diagnosis and management of angina and myocardial infarction

Possible objectives for an audit

An audit on MPS using SPECT could be carried out to ensure that the technique is used appropriately.

Possible patients to be included in the audit

An audit could be carried out on people referred for investigation of coronary artery disease (CAD) and people who have CAD and who remain symptomatic following myocardial infarction, CABG or PCI, for a reasonable period for audit, for example, 3 or 6 months.

Measures that could be used as a basis for audit

The measure that could be used in an audit of MPS using SPECT for people referred for investigation of CAD is as follows.

Criterion

Standard

Exception

Definition of terms

1. MPS using SPECT is carried out in the following circumstances:

a. as the initial diagnostic tool for an individual with suspected CAD for whom sECG poses problems of poor sensitivity or difficulties in interpretation or for whom treadmill exercise is difficult or impossible

b. as part of an investigational strategy for the diagnosis of suspected CAD in an individual with a lower likelihood of CAD and of future cardiac events

100% of people who have suspected CAD and who meet 1a or 1b

None

Clinicians will need to agree locally on how patients are identified as having suspected CAD, for audit purposes.

For 1a, people for whom there may be problems of sensitivity or interpretation include women, people with cardiac conduction defects (for example, left bundle branch block), and people with diabetes. Clinicians will need to agree locally on how a patient for whom treadmill exercise is difficult or impossible is identified, for audit purposes.

For 1b, clinicians will need to agree locally on how the likelihood of CAD and the likelihood of future cardiac events is determined to be low, for audit purposes. Risk factors include age, gender, ethnic group, family history, associated co-morbidities, clinical presentation, physical examination, and results from other investigations (for example, blood cholesterol levels or a resting electrocardiogram).

The measure that could be used in an audit of MPS using SPECT for people with established CAD who remain symptomatic following myocardial infarction, CABG or PCI is as follows.

Criterion

Standard

Exception

Definition of terms

1. MPS using SPECT is carried out as part of an investigational strategy for an individual with established CAD who remains symptomatic following myocardial infarction, CABG or PCI

100% of people with established CAD who remain symptomatic following myocardial infarction, CABG or PCI

None

Clinicians will need to agree locally on the definition of symptomatic for an individual patient that is documented, for audit purposes.

Calculation of compliance

Compliance (%) with each measure described in the table above is calculated as follows.

Number of patients whose care is consistent with the criterion plus number of patients who meet any exception listed

x 100

Number of patients to whom the measure applies

Clinicians should review the findings of measurement, identify whether practice can be improved, agree on a plan to achieve any desired improvement and repeat the measurement of actual practice to confirm that the desired improvement is being achieved.