Impact of the 2016 ASE/EACVI Guidelines on diastolic function reporting in routine clinical practice.

Abstract

To evaluate the impact of 2016 ASE/EACVI guidelines on Diastolic Function (DF) reporting during routine clinical practice. Transthoracic echos performed 9months before and 18months after the 2016 guidelines (DF2016) were retrospectively analyzed. Twenty thousand eight hundred forty three echos performed between July 1, 2015, and September 30, 2017, were analyzed. Quarterly trends showed a stable proportion of normal DF (nDF), diastolic dysfunction (DD), indeterminate DF (DF-I), and nonreported DF (DF-NR) for 3 quarters preceding DF2016. After DF2016 release, reporting of DD decreased by 57% (P<.001), nDF increased by 76% (P<.001), DF-NR increased by 266% (P<.001), and DF-I did not change significantly (P=.40). Grade 1 DD decreased by 64% (P<.001), grade 2 DD decreased by 51% (P<.001), and grade 3 DD did not change significantly (P=.18). Provider level analysis showed increased heterogeneity in grade 1 DD reporting and decreased heterogeneity in DD grades 2 or higher, after DF2016. Systolic dysfunction reporting remained relatively stable (22%→21%→20%) compared to a significant decrease in isolated DD (35%→21%→10%). The 2016 guidelines update has impacted DF reporting patterns significantly. The likelihood of reporting DD decreased significantly, especially for grades 1 and 2. Inter-provider heterogeneity in DF reporting improved for grades 2 and 3 but worsened for grade 1. There was more than threefold increase in failure to report DF, suggesting a decrease in provider confidence.