Author + information
- Anitha Rajamanickam,
- Enoch Arhinful,
- Jaya Bathina,
- Ali Mahmood,
- Yuanyuan Zhang,
- Gaddum Reddy,
- Ehsanur Rahman,
- Edward Goldenberg,
- Erik Marshall and
- William Weintraub
Over the past few decades, there has been a continued increase in utilization and costs of echocardiographic procedures, and concerns have been raised regarding their potential overuse and misuse. Appropriateness criteria have been developed as a physician-directed effort to define proper utilization of echocardiograms. One of the commonest reasons for ordering transthoracic echocardiograms (TTE) is for the assessment of left ventricular function or ejection fraction (LVEF). In clinical practice we have observed that a normal electrocardiogram (EKG) correlates with a normal LVEF. A review of literature did not show any prior studies on this hypothesis.
A query of our medical records revealed that 36,631 TTE were performed between 6/2008 and 6/2011. After eliminating emergency TTEs, we queried for TTEs ordered primarily for evaluation of LVEF, finding 4839. Of these 4734 (98%) had an EKG performed within 7 days prior to the ECHO study and only 321 (7%) had a completely normal EKG. Of the remaining 592 (12%) had borderline EKGS and 3821 (81%) had abnormal EKGs.
All patients with completely normal EKGs had LVEF ≥ 50%. All patients with LVEF< 50% had abnormal EKGs. On review of TTE in patients with normal EKGS, we did not find any abnormalities which would impact management. We did find some minor abnormalities, none of which altered management [Diastolic Dysfunction Stage 1 (20%), Diastolic Dysfunction Stage 2 (9%), Mild pulmonary HTN (8%), Trace/Mild Valvular regurgitation(34%), Valvular Sclerosis(16%), Mild atrial enlargement(12%), Mild LVH(12%) and Interatrial lipomatous hypertrophy and small PFOs(4%)].
Around 20 million echocardiograms are performed yearly. If, approximately, 7% of these patients have a completely normal EKG then at Medicare reimbursement of $792.41 for a complete TTE, avoiding TTE in these patients amount to savings of over $1 billion. As shown in our study, in a stable patient with a completely normal EKG, a transthoracic ECHO is unlikely to offer any additional diagnostic information and is a waste of precious health care resources and dollars
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Improving Cardiovascular Health Services
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1201-114
- 2013 American College of Cardiology Foundation