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(Circulation. 2002;106:300.)
© 2002 American Heart Association, Inc.

Brief Rapid Communications

Impact of a Specific Echocardiographic Report Comment Regarding Endocarditis Prophylaxis on Compliance With American Heart Association Recommendations

Gregory P. Sanders, MD; Susan B. Yeon, MD; Jason Grunes; Todd B. Seto, MD, MPH; Warren J. Manning, MD

From the Department of Medicine (G.P.S., S.B.Y., J.G., W.J.M.), Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, and The Center for Best Healthcare Practices, The Queen’s Medical Center, and the Department of Medicine, Cardiology and Clinical Epidemiology Divisions (T.B.S.), John A. Burns School of Medicine, University of Hawaii, Honolulu.

Reprint requests to Warren J. Manning, MD, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215. E-mail wmanning{at}caregroup.harvard.edu

Background— There is substantial underuse and overuse of antibiotic prophylaxis. Current American Heart Association (AHA) recommendations are heavily dependent on echocardiographic data that may not be familiar to referring physicians. We sought to determine the impact of a specific prophylaxis report comment on compliance with AHA recommendations.

Methods and Results— Using a standardized electronic reporting system, physicians interpreting 50% of echocardiograms included a concluding comment classifying endocarditis risk and stating whether prophylaxis was indicated. The remaining reports were identical in format/content but did not include such comments. Of 1461 eligible outpatients during a 6-month period, 969 (66.3%) responded to a mail survey regarding prophylaxis instructions. Overall, 50% reported taking prophylaxes. Compliance with AHA recommendations was greater among those with a comment (73.2% versus 65.4% for those receiving versus those not receiving comments, respectively; P=0.011), with particular improvement among moderate-risk patients (69.5% versus 59.9%, P=0.024).

Conclusions— An echocardiographic report statement regarding endocarditis risk and need for prophylaxis is a simple low-cost intervention that improves compliance with AHA recommendations. Interpreting physicians should become familiar with AHA recommendations and include a concluding statement addressing prophylaxis.

Key Words: echocardiography • endocarditis • prevention • valves

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