Stressing Wisely is a scenario-based tool for clinicians to understand appropriateness of cardiac testing, including exercise treadmill stress, exercise SPECT stress, pharmacologic SPECT stress, exercise stress echo, pharmacologic stress echo, pharmacologic PET stress, pharmacologic stress MRI, coronary CTA, coronary calcium scoring, and cardiac catheterization, or no testing.
Stressing Wisely harmonizes and expands all published Appropriate Use Criteria (AUC), using inputs of patient-specific characteristics to map recommendations to specific AUC scenarios and guidelines, including references.
There is high variability in the use of cardiac testing.
Appropriate use of cardiac testing may reduce unnecessary radiation exposure, patient risk, and adverse economic impact to patients and society.
AUCs are challenging to use in practice due to the vast number of clinical scenarios and the multi-modality nature of stress imaging.
Stressing Wisely harmonizes:
All clinical scenarios from these guidelines and appropriateness ratings were reviewed and inputted into comprehensive matrices consisting of feature-scenario keys, scenario-rating keys, and rating-justification keys.
Recommendations about appropriateness were based on interweaving of the clinical scenarios, published AUC, modality-specific absolute contraindications, and modality-specific relative contraindications.
Specific decision rules for Stressing Wisely recommendations were developed to expand and cover scenarios not specifically addressed by current AUCs.
The application was coded using R, Shiny, PHP, MySQL, CSS, HTML, Bootstrap, and JS.
Medical Student
