Abstract 093: Use of Echocardiography Following an Elevated B-Type Natriuretic Peptide Level

Abstract

Background: Echocardiography (echo) is recommended for those with an elevated B-type natriuretic peptide (BNP) value and no prior diagnosis of heart failure. We sought to examine the rate of echo use following a BNP value over 100 pg/ml. Methods: We identified patients in the Veterans Affairs (VA) Health Care System with no prior echocardiography within the past five years, no diagnosis of heart failure within the past 2 years, and a BNP value of ≥100 pg/ml. We examined the use of echo during the six months following identification of an elevated BNP value. Multivariable predictors of echo use were evaluated as well, including demographics, prior medical diagnoses, lab values, and institutional teaching status. Results: Among 20,143 patients identified, 6,205 (31%) had an echo during the next 6 months. Among VA hospitals with at least 20 included patients, use of echo ranged from 8.6% to 66% (Figure 1). Patients undergoing echo were younger (mean age 71±12 vs. 74±12, p<0.0001), had higher BNP values (mean value 571±1,524 vs 378±1,127, p<0.0001) and more likely to be of white race (76% vs. 74%, p<0.0001). In multivariate analysis, independent predictors of six-month echo use were age (odds ratio 0.78, 95% CI 0.76-0.80 per 10 year increase), female gender (0.79, 0.66-0.94 vs. male), race (black 0.87, 0.79-0.95 vs. white) and academic affiliation (Council of Teaching Hospital Member (COTH) 2.11, 1.87-2.38, academic but not COTH 1.74, 1.54-1.96 vs. non-academic). Conclusion: Following an elevated BNP value, an echocardiogram was ordered in only 31% with a wide range across different VA medical centers. Gender and racial disparities were present.