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Echocardiography may be underutilized during critical CV hospitalizations
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Despite an increase of use in recent years, echocardiography may still be underutilized during critical CV hospitalizations, according to data published in the Journal of the American College of Cardiology.
Researchers examined national trends, practice patterns and patient outcomes associated with echocardiography use reported in the Nationwide Inpatient Sample. The primary endpoint was all-cause in-hospital mortality and the association with echocardiography use.
From 2001 to 2011, an estimated 7,669,000 echocardiography examinations were conducted in U.S. hospitals. The absolute volume and incidence of echocardiography increased by annual rates of 3.41% and 3.04%, respectively. Analysis by geographic distribution revealed that Rhode Island, New York and Montana had the highest use and Wyoming, Alaska and New Mexico had the lowest use of echocardiography.
In 2010, approximately 816,500 echocardiography studies were performed nationwide. The use of echocardiography was associated with lower inpatient mortality risk for acute MI (adjusted OR = 0.74; 95% CI, 0.63-0.86), cardiac dysrhythmia (adjusted OR = 0.72; 95% CI, 0.55-0.94), acute cerebrovascular disease (adjusted OR = 0.36; 95% CI, 0.31-0.42), congestive HF (adjusted OR = 0.82; 95% CI, 0.72-0.94) and sepsis (adjusted OR = 0.77, 95% CI, 0.70-0.85). However, although these five diagnoses represented 9% of all hospitalizations, only 8% of these patients underwent echocardiography.
The researchers also conducted a single-center validation analysis at Mount Sinai Medical Center between 2003 and 2014. There, echocardiography examinations were performed during 14.6% of the 57,547 hospitalizations in 2014. The researchers noted that there was a particular underutilization of echocardiography for patients with acute MI. Twenty-five percent of patients with MI did not receive an echocardiography evaluation and 17% did not receive any cardiac imaging before discharge. The mortality rate was higher for patients who did not receive an echocardiography evaluation (101.1% vs. 9.1%).
“An evaluation of resource use and patients’ outcomes found that hospitalizations in which [echocardiography] was coded as the primary procedure had declining rates of hospital mortality and length of stay,” the researchers wrote. “However, these trends were associated with rising hospitalization charges.” – by Tracey Romero
Disclosure: Papolos reports no relevant financial disclosures. One researcher reports receiving research grants from GE Healthcare and Philips Healthcare (equipment). Another researcher reports serving as an adviser to Saffron Technology Hearts Labs and as a consultant to Edwards Lifesciences.
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