Abstract 12429: What is the Clinical Impact of Echocardiography Among Hospitalized Patients With Prior Testing?

Abstract

Introduction: The versatility and safety of transthoracic echocardiography (TTE) has made it one of the most frequently ordered cardiac imaging tests. However, for inpatients with prior TTE results, the clinical impact of repeat TTE remains uncertain. Methods: We evaluated the charts of sequential hospitalized patients with prior TTE results who underwent an inpatient TTE. We noted prior and current TTE results, if imaging findings were abnormal [(using definitions from Hua (Echocardiography, 2017)], and if these findings were significantly different between the studies. We then evaluated all records for changes in clinical management, including medication changes, additional diagnostic testing, new specialty consultation, or invasive procedures. We used a multivariable model to determine predictors of changes in clinical management. Results: Of 229 sequential patients who underwent an inpatient TTE [median age 71, 55% male, 90% white, 67% abnormal prior TTE], most met Appropriate Use Criteria (92%), most were abnormal (80%), and most changed in at least one aspect from the prior study (66%). However, despite the majority of repeat TTEs with new changes, clinical management was impacted in only a minority of cases 61 (27%). Of these, 27 (12%) resulted in medication changes; 15 (6%) had further diagnostic testing; 14 (6%) had a new specialty consultation; and 11 (4%) had invasive procedures ordered (cardiac catheterization, pericardial drain placement, and cardiac surgery). After adjusting for ordering provider, race of patient, and study indication, new findings on the TTE predicted changes in clinical management OR 4.2, p<0.001). Conclusion: Despite the large majority of repeat TTE’s meeting AUC guidelines, being abnormal, and having imaging changes, repeat TTE infrequently impacted clinical management. Although new TTE abnormalities are associated with clinical management changes in some cases, the clinical value of repeat TTE in the setting of prior imaging results may be lower than most clinicians assume. Efforts to identify the population for whom TTE studies are most likely to impact clinical care would increase the clinical yield of repeat TTE.