Pre-operative echocardiography among patients with coronary artery disease in the United States Veterans Affairs healthcare system: A retrospective cohort study

Emily B. Levitan, Laura A. Graham, Javier A. Valle, Joshua S. Richman, Robert Hollis, Carla N. Holcomb, Thomas M. Maddox, Mary T. Hawn

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Echocardiography is not recommended for routine pre-surgical evaluation but may have value for patients at high risk of major adverse cardiovascular events (MACE). The objective of this study was to evaluate whether pre-operative echocardiography is associated with lower risk of post-operative MACE among patients with coronary artery disease. Methods: Using administrative and registry data, we examined associations of echocardiography within 3 months prior to surgery with postoperative MACE (myocardial infarction, revascularization, or death within 30 days) among patients with coronary artery disease undergoing elective, non-cardiac surgeries in the United States Veterans Affairs healthcare system in 2000-2012. Results: Echocardiography preceded 4,378 (16.4%) of 26,641 surgeries. MACE occurred within 30 days following 944 (3.5%) surgeries. A 10% higher case-mix adjusted rate of pre-operative echocardiography assessed at the hospital level was associated with a hospital-level risk of MACE that was 1.0% (95% confidence interval [CI] 0.1%, 2.0%) higher overall and 1.7% (95% CI 0.2%, 3.2%) higher among patients with recent myocardial infarction, valvular heart disease, or heart failure. At the patient level, pre-operative echocardiography was associated with an odds ratio for MACE of 1.9 (95% CI 1.7,2.2) overall and 1.8 (95% CI 1.5, 2.2) among patients with recent myocardial infarction, valvular heart disease, or heart failure adjusting for MACE risk factors. Conclusions: Pre-operative echocardiography was not associated with lower risk of post-operative MACE, even in a high risk population. Future guidelines should encourage pre-operative echocardiography only in specific patients with cardiovascular disease among whom findings can be translated into effective changes in care.

Original languageEnglish (US)
Article number173
JournalBMC Cardiovascular Disorders
Volume16
Issue number1
DOIs
StatePublished - Sep 5 2016
Externally publishedYes

Fingerprint

Veterans
Echocardiography
Coronary Artery Disease
Cohort Studies
Retrospective Studies
Delivery of Health Care
Confidence Intervals
Heart Valve Diseases
Myocardial Infarction
Heart Failure
Myocardial Revascularization
Diagnosis-Related Groups
Registries
Cardiovascular Diseases
Odds Ratio
Guidelines
Population

Keywords

  • Echocardiography
  • Major adverse cardiac events
  • Surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Pre-operative echocardiography among patients with coronary artery disease in the United States Veterans Affairs healthcare system : A retrospective cohort study. / Levitan, Emily B.; Graham, Laura A.; Valle, Javier A.; Richman, Joshua S.; Hollis, Robert; Holcomb, Carla N.; Maddox, Thomas M.; Hawn, Mary T.

In: BMC Cardiovascular Disorders, Vol. 16, No. 1, 173, 05.09.2016.

Research output: Contribution to journalArticle

Levitan, Emily B. ; Graham, Laura A. ; Valle, Javier A. ; Richman, Joshua S. ; Hollis, Robert ; Holcomb, Carla N. ; Maddox, Thomas M. ; Hawn, Mary T. / Pre-operative echocardiography among patients with coronary artery disease in the United States Veterans Affairs healthcare system : A retrospective cohort study. In: BMC Cardiovascular Disorders. 2016 ; Vol. 16, No. 1.
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abstract = "Background: Echocardiography is not recommended for routine pre-surgical evaluation but may have value for patients at high risk of major adverse cardiovascular events (MACE). The objective of this study was to evaluate whether pre-operative echocardiography is associated with lower risk of post-operative MACE among patients with coronary artery disease. Methods: Using administrative and registry data, we examined associations of echocardiography within 3 months prior to surgery with postoperative MACE (myocardial infarction, revascularization, or death within 30 days) among patients with coronary artery disease undergoing elective, non-cardiac surgeries in the United States Veterans Affairs healthcare system in 2000-2012. Results: Echocardiography preceded 4,378 (16.4{\%}) of 26,641 surgeries. MACE occurred within 30 days following 944 (3.5{\%}) surgeries. A 10{\%} higher case-mix adjusted rate of pre-operative echocardiography assessed at the hospital level was associated with a hospital-level risk of MACE that was 1.0{\%} (95{\%} confidence interval [CI] 0.1{\%}, 2.0{\%}) higher overall and 1.7{\%} (95{\%} CI 0.2{\%}, 3.2{\%}) higher among patients with recent myocardial infarction, valvular heart disease, or heart failure. At the patient level, pre-operative echocardiography was associated with an odds ratio for MACE of 1.9 (95{\%} CI 1.7,2.2) overall and 1.8 (95{\%} CI 1.5, 2.2) among patients with recent myocardial infarction, valvular heart disease, or heart failure adjusting for MACE risk factors. Conclusions: Pre-operative echocardiography was not associated with lower risk of post-operative MACE, even in a high risk population. Future guidelines should encourage pre-operative echocardiography only in specific patients with cardiovascular disease among whom findings can be translated into effective changes in care.",
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AU - Levitan, Emily B.

AU - Graham, Laura A.

AU - Valle, Javier A.

AU - Richman, Joshua S.

AU - Hollis, Robert

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AU - Maddox, Thomas M.

AU - Hawn, Mary T.

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AB - Background: Echocardiography is not recommended for routine pre-surgical evaluation but may have value for patients at high risk of major adverse cardiovascular events (MACE). The objective of this study was to evaluate whether pre-operative echocardiography is associated with lower risk of post-operative MACE among patients with coronary artery disease. Methods: Using administrative and registry data, we examined associations of echocardiography within 3 months prior to surgery with postoperative MACE (myocardial infarction, revascularization, or death within 30 days) among patients with coronary artery disease undergoing elective, non-cardiac surgeries in the United States Veterans Affairs healthcare system in 2000-2012. Results: Echocardiography preceded 4,378 (16.4%) of 26,641 surgeries. MACE occurred within 30 days following 944 (3.5%) surgeries. A 10% higher case-mix adjusted rate of pre-operative echocardiography assessed at the hospital level was associated with a hospital-level risk of MACE that was 1.0% (95% confidence interval [CI] 0.1%, 2.0%) higher overall and 1.7% (95% CI 0.2%, 3.2%) higher among patients with recent myocardial infarction, valvular heart disease, or heart failure. At the patient level, pre-operative echocardiography was associated with an odds ratio for MACE of 1.9 (95% CI 1.7,2.2) overall and 1.8 (95% CI 1.5, 2.2) among patients with recent myocardial infarction, valvular heart disease, or heart failure adjusting for MACE risk factors. Conclusions: Pre-operative echocardiography was not associated with lower risk of post-operative MACE, even in a high risk population. Future guidelines should encourage pre-operative echocardiography only in specific patients with cardiovascular disease among whom findings can be translated into effective changes in care.

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