Abstract 241: Utility and Appropriateness of Echocardiography - Insights from Nonagenarians
Background: More than 20 million echocardiograms are performed every year in the United States at an average cost of approximately five hundred dollars per study. Despite this large expense, these studies can provide significant information that influences patient care. In the fast growing segment of nonagenarians, we sought to determine if echocardiograms have been appropriately obtained according to current Appropriate Use Criteria (AUC).
Methods: Over a one-year period at Baylor Scott and White Memorial Hospital, the following characteristics of echocardiography cases performed for elderly patients (90 years and older) were summarized according to Appropriate Use Criteria class: age, gender, patient origin (inpatient/outpatient), type of study (TTE/TEE), and clinical service. Each characteristic was compared among 3 AUC classes (appropriate, inappropriate, and undetermined). ANOVA or Kruskal-Wallis test was used for continuous variable comparisons and Chi-square test or Fisher’s exact test was used for categorical variable comparisons. Proportion (95% confidence interval (CI)) of cases that received echocardiography due to appropriate reasons was estimated for entire group. A p-value of less than 0.05 indicated a statistical significance.
Results: Four hundred eighty cases that met inclusion criteria were included in the analysis. Among 480 cases, 91% (435 cases, 95% CI (88-93%)) were conducted due to appropriate reasons. Four percent (21 cases, 95% CI (3-7%)) were performed due to inappropriate reasons and 5% (24 cases, 95% CI (3-7%)) were done due to undetermined reasons. There were no significant differences among the three AUC classes by age, gender, or type of study. However, there are significant differences (P<0.05) among the three AUC classes in regards to clinical service requesting the study and site of origin of the patient.
Conclusions: 9% of echocardiograms performed in this demographic, including 26% of outpatient studies, were not appropriate according to current AUC. There was significant variance between referring service and by site of origin. Investigation in larger groups of patients may provide enhanced awareness of and improved adherence to AUC.
Author Disclosures: T. Delmas: None. A. Anderson: None. B. Barnett: None.
- © 2014 by American Heart Association, Inc.