MedicalResearch.com Interview with:
Quinn R Pack, MD
Assistant Professor of Medicine
University of Massachusetts Medical School –
Baystate Adjunct Assistant Professor of Medicine
Tufts University School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Because echocardiograms are non-invasive, very low risk, and nearly universally available, it is easy to over-use this technique. In myocardial infarction, echo is also recommended in guidelines.
However, in our lab, we frequently find echocardiograms that are ordered purely out of routine, without any thought as to the likelihood of finding an abnormality. Prior studies also suggested that as many as 70% of echocardiograms provide no additional diagnostic value. When spread across the approximate 600,000 patients in the United States each year, this low diagnostic yield represents an opportunity to reduce costs by reducing echocardiograms.
MedicalResearch.com: What should readers take away from your report?
Response: When looking at the hospital level, some hospitals use echocardiography almost universally and other hospitals use it in only about 50% of patients with myocardial infarction. However, the hospitals with high use rates (about 85%) had no differences in mortality or readmission. However, high-use hospitals had higher costs (+$3,000) and longer hospital stays. These suggest that echocardiography can be used less often and does not need to be universally used in these patients. These findings are likely to be particularly true at high-use hospitals.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Additional studies are needed to help sort out which patients do not benefit from an echocardiogram during a heart attack.
Our study mainly suggests that guidelines that recommend universal echocardiography should be reconsidered. Similarly, protocols that automatically order an echo without any thought as to the likelihood of finding an abnormality should be reconsidered.
Pack QR, Priya A, Lagu T, et al. Association Between Inpatient Echocardiography Use and Outcomes in Adult Patients With Acute Myocardial Infarction. JAMA Intern Med. Published online June 17, 2019. doi:10.1001/jamainternmed.2019.1051
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