Transthoracic Echocardiograms: Most Lead to No Appreciable Change in Patient Care

Susan Matulevicius, MD, MSCS  Department of Medicine, The University of Texas Southwestern Medical Center, Interview with:
Susan Matulevicius, MD, MSCS

Department of Medicine, The University of Texas Southwestern Medical Center, Dallas What are the main findings of the study?

Dr. Matulevicius: In our cohort of 535 transthoracic echocardiograms performed at a single academic medical center, we found that the majority (92%) of echocardiograms were appropriate by the 2011 Appropriate Use Criteria; however, only 1 in 3 echocardiograms lead to an active change in patient care while 1 in 5 resulted in no appreciable change in patient care. Were any of the findings unexpected?

Dr. Matulevicius: The low rate of active change in care (31.8%) in echocardiograms mostly classified as appropriate (91.8%) is surprising and highlights the need for a better method to optimize echocardiography’s utilization of limited health care resources efficiently in the deliver of high value care. What should clinicians and patients take away from your report?

Dr. Matulevicius: A diagnostic test, unlike a therapeutic test, may be appropriate in its ability to diagnose a certain disease process but not necessary because the clinical history, physical, and laboratory data may be enough to provide high value care.¬†Clinicians and patients should consider what information will be gained from any diagnostic test, including echocardiograms, and ask how this additional information will add to their clinical care. If the answer, it will do nothing, then potentially the study should not be ordered and care should proceed without investing additional time and resources into diagnostic testing. This should prompt physicians and patients to engage in open conversations about the likely etiology of the patient’s symptoms, the potential treatments for that condition, and the expected results of testing and treatment. What recommendations do you have for future research as a result of this study?

Dr. Matulevicius: Diagnostic testing has always been evaluated on its ability to detect disease (sensitivity and specificity) but not on its ability to impact patient care. Hopefully this study will inspire the imaging community to develop standardized patient-centered definitions against which the value of a diagnostic test to patient care can be compared between testing modalities as well as with and without testing. Similarly, future studies that examine the patient, physician, and environmental factors associated with clinically impactful diagnostic tests may help inform when additional testing may be most beneficial.


Appropriate Use and Clinical Impact of Transthoracic Echocardiography

Matulevicius SA, Rohatgi A, Das SR, Price AL, deLuna A, Reimold SC. Appropriate Use and Clinical Impact of Transthoracic Echocardiography. JAMA Intern Med. 2013;():-. doi:10.1001/jamainternmed.2013.8972.

Last Updated on April 10, 2015 by Marie Benz MD FAAD