Key result
Inpatient echocardiography is linked to ~26% lower mortality in acute MI and other acute conditions.
Why the study?
Increased use of echocardiography in the United States raises questions about potential overuse and its association with patient outcomes during hospitalization.
Does inpatient echocardiography use improve all-cause inpatient mortality in critical cardiovascular hospitalizations?
Observational (n=3,700,000)
Yes
Does inpatient echocardiography use improve all-cause inpatient mortality in critical cardiovascular hospitalizations?
Odds Ratio: 0.74 (95% CI 0.63–0.86)
p-value: p=<0.001
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“If you perform the echo and you see that the patient has LV dysfunction, you would start them on an ACE inhibitor or ARB, and that's very important in the process of remodeling. But if you don't know the ejection fraction because you didn't do the echo, you might not start them immediately on these drugs, and that's when problems happen.”
“Given this rapidly expanding utility of echocardiography, there has been a perception that it is overused and potentially employed inappropriately in many instances. Although these claims have never been substantiated, they have gathered traction amongst the medical community and resulted in documented appropriate use criteria.”
Despite rising overall utilization rates, inpatient echocardiography is associated with reduced mortality and may be underused during critical cardiovascular hospitalizations.
BACKGROUND: Increased use of echocardiography (echo) raises questions of whether echo is an overused diagnostic procedure in the United States. OBJECTIVES: This study investigated national trends, practice patterns, and patient outcomes associated with inpatient echo use reported in the Nationwide Inpatient Sample (NIS). METHODS: We identified admission diagnoses most commonly associated with echo use and performed multivariate logistic regression within each diagnosis cohort to assess whether echo use was associated with all-cause inpatient mortality. Secondary analysis was performed within our institution to validate use trends identified in the NIS database. RESULTS: Between 2001 and 2011, the absolute volume and incidence of echo steadily increased at average annual rates of 3.41% and 3.04%, respectively. In 2010, the use of echo was associated with lower odds of inpatient mortality among hospitalizations for acute myocardial infarction (adjusted odds ratio [OR]: 0.74; 95% confidence interval [CI]: 0.63 to 0.86; p < 0.001), cardiac dysrhythmia (adjusted OR: 0.72; 95% CI: 0.55 to 0.94; p = 0.02), acute cerebrovascular disease (adjusted OR: 0.36; 95% CI: 0.31 to 0.42; p < 0.001), congestive heart failure (adjusted OR: 0.82; 95% CI: 0.72 to 0.94; p = 0.005), and sepsis (adjusted OR: 0.77; 95% CI: 0.70 to 0.85; p < 0.001). In 2010, these 5 diagnoses accounted for 3.7 million hospital admissions (9% of all hospitalizations); however, echo was reported in only 8% of cases. Secondary analysis of imaging practices at our institution confirmed underuse of echo among patients who died during hospitalization for indications identified in the NIS database. CONCLUSIONS: Despite increasing rates of performance, echo may be underused during critical cardiovascular hospitalizations.
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Papolos et al. (2016) conducted an observational in Acute myocardial infarction, cardiac dysrhythmia, acute cerebrovascular disease, congestive heart failure, and sepsis (n=3,700,000). Echocardiography vs. No echocardiography was evaluated on All-cause inpatient mortality (acute myocardial infarction cohort) (OR 0.74, 95% CI 0.63-0.86, p=<0.001). Inpatient echocardiography was associated with lower mortality for acute MI (OR 0.74; 95% CI 0.63-0.86), dysrhythmia, stroke, heart failure, and sepsis.
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