P2631Improved attitudes of non-cardiologists towards decreased left ventricular ejection fraction after marking “warning on echocardiography report”

Abstract

Abstract Background Echocardiography (echo) has become a well-accepted noninvasive examination for patients with confirmed or suspected cardiac structural and/or functional abnormalities, by not only heart doctors but also non-heart doctors. Left ventricular ejection fraction (LVEF) as the most important parameter of cardiac systolic function must be listed on every echo report. A LVEF of <50% has been regarded as LV systolic dysfunction with reduced ejection fraction. Purpose This study aimed to test whether a warning label as “reduced LVEF” on echo report would change the attitude or practice with regard to heart failure (HF) diagnosis and treatment in non-heart doctors. Methods From January to June, 2018, the program was conducted by adding a warning label as “reduced LVEF” next to the LVEF reading on echo report if it was <50%. The patients with a reported LVEF <50% and an echo request from non-heart doctors (cardiologists or cardiac surgeons) were selected (labeled group, n=359) for analysis, and a similar group of patients from January to June, 2017 were served as controls (unlabeled group, n=367). The rates of HF diagnosis, N-terminal-pro-B-type natriuretic peptide (NT-proBNP) test, cardiologist consultation and anti-HF medical therapy at discharge were compared between the 2 groups. Results There were no major differences in baseline characteristics between the 2 groups. The labeled group received more opportunities of cardiologist consultation (53.2% vs. 44.7%, p=0.02) and referral to cardiology outpatient clinic (57.9% vs. 50.1%, p=0.04) when compared with the unlabeled group. However, the difference was mainly found in patients with a LVEF of 40–49% (n=448, 53.2% of the labeled group vs. 44.7% of the unlabeled group, p=0.02). By pooling the data from the labeled and unlabeled groups, the patients who received cardiologist consultation (n=355) had a significant improvement in HF diagnosis and management than those who did not have a chance of cardiologist consultation (n=371), in terms of higher rates of NT-proBNP test (59.6% vs. 80.8%, p<0.01) and standardized anti-HF medication (Renin-anigotensin system inhibitors: 23.7% vs. 37.2%, p<0.01; β blockers: 22.1% vs. 33.8%, p<0.01; mineralocorticoid Receptor Antagonists: 27.5% vs. 35.5%, p<0.01). Conclusions An added warning label as “reduced LVEF” on echo report beside the LVEF reading would enhance the awareness of systolic HF and the appropriate management in non-heart doctors, in particular for patients with a LVEF of 40∼49%. Acknowledgement/Funding The study was supported by a research grant from the Science and Technology Department of Sichuan Province (project number: 2017SZ0059)