133 Echocardiography in Pre-Surgical Assessment: Are we Following European Society of Cardiology Guidance?

Abstract

Background Echocardiography is widely available and utilised for a variety of reasons. The recent European Society of Cardiology (ESC) guidance on pre-operative cardiac assessment quantifies which patients require Echocardiography, formal Cardiology opinion and further functional imaging. This is based on the risk of surgical intervention, cardiac risk factors and functional status. Increasing demands have put added strain on Echocardiography services often resulting in delay for both in and outpatient scans. Currently there is no formal cardiac risk assessment tool at our local Trust for pre-operative patients. Aim To investigate the appropriateness of referral for pre-operative Echocardiography in our District General Hospital. Requests for Echocardiography were correlated with new ESC Guidelines for pre-operative cardiac assessment in non-cardiac surgery. Outcomes following initial Echocardiography were also assessed. Method Retrospective analysis of pre-operative Echocardiography requests over twelve months. Requests for Echocardiography by Surgical Consultants were obtained and subsequently analysed using an assessment tool based on ESC guidance. Results There were 123 requests over the time period, of which 89 were for pre-operative assessment. Of these 34 (38%) were deemed appropriate based on ESC guidance, 25 (28%) were inappropriate and 30 (34%) recorded inadequate information. Of the appropriate requests 18 were subsequently referred for Cardiology assessment prior to surgery. Of these a further 8 underwent functional imaging and 2 were referred for angiography. In the requests which did not give adequate information, all did not record patient’s functional status. Conclusions Echocardiography is being requested for pre-surgical assessment inappropriately. Inappropriate referrals put pressure on already stretched departments resulting in increased waiting times for both out and inpatient echocardiography. This retrospective analysis identifies that assessment of patients functional assessment was poor and a significant contributing factor to inappropriate request for echocardiography. This study represents the tip of the iceberg in terms of inappropriate request for cardiac imaging in pre-operative assessment and highlights a waste of resource. Only in 38% of cases were echocardiograms requested appropriately based on ESC guidelines. It is clear that guidance for health care professionals running pre-operative clinics needs to be implemented. Based on this we intend to develop and implement a pre-assessment tool and re-assess requests for echocardiography.