Kadkhodayan, Ana

Introduction: Transthoracic echocardiography (TTE) is a versatile tool for investigating cardiac function in hospitalized patients, but it was recently suggested that only a fraction of the studies result in an active change in management. The importance of early inpatient TTE to guide management and rule out important alternative pathology has not been previously investigated. The opinion of the referring provider has never been systematically surveyed. Hypothesis: Appropriate use (AU) of TTE in hospitalized patients has significant implications for patient care, even without resulting in direct alterations in management. Methods: We conducted a prospective review of 546 consecutive echocardiograms performed within 72 hours of hospital admission. An electronic survey consisting of 6 questions pertinent to rationale for TTE and consequences to patient care was sent to physicians. AU was independently determined by two investigators blinded to survey results and clinical outcomes, with differences adjudicated by a third independent investigator. Results: Of 546 TTEs included in this study, 526 (96%) were appropriate, 2% inappropriate, and 2% uncertain. Although only 48% of responders actively changed management after TTE results, 97% thought the TTE answered their clinical question. At least one new medication change occurred in 190 (35%) patients. Moreover, 95% of physicians would do another TTE in a similar situation, either to guide cardiac therapy, rule out contributing cardiac pathology, or support their current therapeutic plan. Only 5% of responders would not order another TTE if given a similar presentation in the future. Furthermore, our study uncovered a high incidence of unexpected findings (33% of TTEs), ranging from new decrease in LV systolic function, new valvular dysfunction, to pericardial effusion and new aortic aneurysm. These findings have significant clinical implications for the individual patient. Conclusions: Most early inpatient TTEs at our institution were appropriate and answered a specific clinical question important for management decisions. Even those not directly altering the acute therapeutic strategy impacted clinical course. A large number of significant incidental findings were recorded.