Abstract 11219: Impact of Echocardiographic Assessment During First Outpatient Cardiology Consultation on Patient Management

Abstract

Background: Goal directed point of care echo (POCE) has emerged as a quick, bedside tool to assess cardiac structure and function. However, impact of physician performed POCE during cardiac consultation on immediate patient diagnosis, downstream testing and management has not been assessed. Purpose: To study the impact of POCE performed by consulting cardiologist (CC) during initial cardiology consult. Methods: 69 study patients (pts) underwent examination by an expert imaging CC from Jan 2014-May 2016. During 1-hour consultation, medical records were reviewed, medical history and physical exam was performed followed by cardiologist-performed POCE (Philips CX50). We included a matched control group of 65 pts seen by 3 different CCs during the same time period who underwent standard echo (Secho) up to 3 months after the initial visit. Results: Baseline characteristics were comparable between the two groups for age (mean of 62 ) , cardiac risk factors, and referral diagnoses. POCE findings and Secho (mean delay of 17.2 days after visit) are shown in Table1 and diagnostic tests ordered following initial visit in both groups in Figure 1. POCE had greater yield of echo abnormalities and led to less referral for noninvasive stress testing, more cardiovascular medication changes (15.3 vs 5.7% pts) and more advanced cardiac testing (21 vs 9% pts) compared to the control group after the initial visit. Conclusion: Focused echo at time of consultation leads to more medication adjustments, less referral for noninvasive stress testing, earlier referral for advanced cardiac diagnostic imaging and shortens time to advanced diagnostic workup by about two weeks.