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The association of abnormal findings on transthoracic echocardiography with 2011 Appropriate Use Criteria and clinical impact

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Abstract

Transthoracic echocardiography (TTE) Appropriate Use Criteria (AUC) were developed to promote high-value care. We describe the prevalence of clinically significant abnormal TTE findings overall and in subgroups defined by appropriate and inappropriate AUC, and their association with clinical impact. 548 consecutive TTEs at an academic medical center were retrospectively reviewed for AUC, clinical impact, and TTE abnormalities. TTE reports within 1 year of the index TTE were reviewed to determine if abnormalities were new, unchanged, or resolved. Clinical impact was classified into no change, active change, or continuation of care. 91 % of TTEs were appropriate, 5 % were inappropriate, and 4 % were uncertain by AUC. 46 % of all TTEs and 57 % of first-time TTEs had no significant TTE abnormalities. Appropriate TTEs had a higher prevalence of ≥1 TTE abnormality than inappropriate TTEs (56 vs. 33 %, p = 0.029). Among repeat TTEs, 72 % had ≥1 TTE abnormality, however only 25 % had a new abnormality. The prevalence of a new abnormality was similar between inappropriate and appropriate repeat TTEs (25 vs. 26 %, p = 1.0). The prevalence of ≥1 abnormality was similar between TTEs that resulted in active change and no change in care (70 vs. 64 %, p = 0.06). Although most TTEs were appropriate as defined by AUC, the majority had no significant abnormalities. Although most TTEs were appropriate by AUC, >50 % of all TTEs and 25 % of repeat TTEs had no significant abnormalities. Appropriate TTEs had a higher prevalence of abnormalities, however the prevalence of abnormalities was similar between TTEs that resulted in active change versus no change in care.

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Acknowledgments

Supported in part by grant UL1TR000451 from the UT-STAR, National Center for Advancing Translational Sciences, National Institutes of Health. Susan Matulevicius, M.D. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The content is solely the responsibility of the authors and does not necessarily represent the official views of UT-STAR, UT Southwestern Medical Center and its affiliated academic and health care centers, the National Center for Advancing Translational Sciences, or the National Institutes of Health.

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Authors and Affiliations

  1. Department of Medicine, University of Texas Southwestern Medical Center, 5909 Harry Hines Boulevard, Dallas, TX, 75390-9047, USA

    Thomas P. Koshy, Anand Rohatgi, Sandeep R. Das, Angela L. Price, Andres deLuna, Sharon C. Reimold & Susan A. Matulevicius

  2. Northwestern University, Evanston, IL, USA

    Nicholas Reimold

  3. University of Texas Austin, Austin, TX, USA

    Kyle Willett

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  1. Thomas P. Koshy
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  9. Susan A. Matulevicius
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Correspondence to Susan A. Matulevicius.

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Koshy, T.P., Rohatgi, A., Das, S.R. et al. The association of abnormal findings on transthoracic echocardiography with 2011 Appropriate Use Criteria and clinical impact. Int J Cardiovasc Imaging 31, 521–528 (2015). https://doi.org/10.1007/s10554-014-0582-x

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  • DOI: https://doi.org/10.1007/s10554-014-0582-x

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