Appropriateness and subsequent management of inpatient echocardiograms: An evaluation of low value care

Abstract

Study objective: Transthoracic echocardiograms (TTE) are perceived to be overused and multiple TTEs are often ordered within one inpatient visit with unclear utility. This study identified inpatients who received multiple TTEs to determine the appropriateness, results, and subsequent management of repeat TTEs. Design: Retrospective Cohort Study. Setting: Single academic medical center. Participants: Subjects over age 18 who underwent >1 TTE during hospitalization in 2020. Interventions: N/A Main outcome measures: Appropriateness of TTE, TTE results, subsequent changes in management. Results: Of the 875 subjects, the average age was 60 years old with a male predominance (57.8%). In comparing the first and second TTE results, the frequency of new abnormal findings decreased significantly from 44.7% to 15.1% (p < .0001). Changes in clinical management in relation to the TTEs decreased from 47.1% to 32.5% (p < .0001), of which medication changes were most common. The majority of tests were appropriate, with a slight increase of inappropriate TTEs from 0.6% to 1.8% (p < .0001) between first and second TTEs. Conclusions: While the rate of inappropriate TTE use increased after the initial TTE, the overall rate of inappropriate use was very small indicating that stricter adherence to AUC would not appreciably reduce duplication of inpatient TTEs. The non-negligible frequency of new abnormal findings for the repeat TTEs at 15% cannot be ignored. Our data suggests that the assumption that repeat TTEs are in large part unnecessary is more complicated than originally thought.

Keywords

• Echocardiography
• Appropriate use
• Clinical management
• Cardiac imaging
• Diagnostic testing