The association of abnormal findings on transthoracic echocardiography with 2011 Appropriate Use Criteria and clinical impact

Thomas P. Koshy, Anand Rohatgi, Sandeep R. Das, Angela L. Price, Andres deLuna, Nicholas Reimold, Kyle Willett, Sharon C. Reimold, Susan A. Matulevicius

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

Transthoracic echocardiography (TTE) Appropriate Use Criteria (AUC) were developed to promote high-value care. We describe the prevalence of clinically significant abnormal TTE findings overall and in subgroups defined by appropriate and inappropriate AUC, and their association with clinical impact. 548 consecutive TTEs at an academic medical center were retrospectively reviewed for AUC, clinical impact, and TTE abnormalities. TTE reports within 1 year of the index TTE were reviewed to determine if abnormalities were new, unchanged, or resolved. Clinical impact was classified into no change, active change, or continuation of care. 91 % of TTEs were appropriate, 5 % were inappropriate, and 4 % were uncertain by AUC. 46 % of all TTEs and 57 % of first-time TTEs had no significant TTE abnormalities. Appropriate TTEs had a higher prevalence of ≥1 TTE abnormality than inappropriate TTEs (56 vs. 33 %, p = 0.029). Among repeat TTEs, 72 % had ≥1 TTE abnormality, however only 25 % had a new abnormality. The prevalence of a new abnormality was similar between inappropriate and appropriate repeat TTEs (25 vs. 26 %, p = 1.0). The prevalence of ≥1 abnormality was similar between TTEs that resulted in active change and no change in care (70 vs. 64 %, p = 0.06). Although most TTEs were appropriate as defined by AUC, the majority had no significant abnormalities. Although most TTEs were appropriate by AUC, >50 % of all TTEs and 25 % of repeat TTEs had no significant abnormalities. Appropriate TTEs had a higher prevalence of abnormalities, however the prevalence of abnormalities was similar between TTEs that resulted in active change versus no change in care.

Original languageEnglish (US)
Pages (from-to)521-528
Number of pages8
JournalInternational Journal of Cardiovascular Imaging
Volume31
Issue number3
DOIs
StatePublished - Mar 21 2015

Keywords

  • Appropriate use criteria
  • Clinical decision-making
  • Echocardiography
  • Health services
  • Retrospective study

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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