Abstract 15808: Frequency and Impact of Repeat Transthoracic Echocardiography in Inpatients Transferred for Transcatheter Aortic Valve Replacement

Abstract

Introduction: Appropriate ordering of cardiac imaging is an important factor in optimizing cardiac testing and resource utilization. Echocardiography is frequently repeated when patients are transferred from one hospital facility to another. This single-center retrospective study aimed at assessing the frequency of repeat transthoracic echocardiography (TTE) and its clinical implications prior to non-elective transcatheter aortic valve replacement (TAVR) in patients transferred from referring hospitals. Methods: During a 2-year period there were 62 patients (32 male; mean age 79.8 + 9.4 yrs) transferred from referring hospitals to an academic referral hospital for non-elective TAVR.. All patients had a TTE performed prior to transfer. Patients were grouped based on whether the accepting hospital performed a repeat TTE prior to the TAVR procedure during the index admission. Values for left ventricular ejection fraction (LVEF), calculated aortic valve area, mean aortic valve (AV) gradient, and peak aortic valve gradient were compared between the outside and accepting hospital TTE reports. Results: Of the 62 hospital transfers, 34 (54.8%) had a repeat TTE performed by the accepting hospital. Average time waiting for a repeat TTE was 2.3 + 1.5 days. Measurements of LVEF (48.8% + 14.5 vs 51.7 + 16.2 [P=0.44]), aortic valve area (0.7 + 0.2 vs 0.7 + 0.2 [P=0.53]), mean AV gradient (46.2 + 18.7 vs 45.1 + 14.8 [P=0.78]) and peak AV gradient (76.2 + 31.3 vs 74.9 + 23.3 [P=0.86]) among patients who had a repeat TTE performed by the accepting hospital were not statistically different than values obtained at the referring hospitals. Conclusions: Patients transferred to an academic referral center for TAVR had repeat TTE performed more than half of the time. Our data indicate that key echocardiographic parameters (LVEF, aortic valve area, and AV gradients) were not different between the TTEs at the referring and accepting hospitals. It is possible that improved digital efforts at image sharing across hospitals may obviate the need for repeat cardiac imaging and improve efficiency of care. Such efforts may impact hospital length of stay and cost, and warrants further study on a larger scale.