Published Online
on June 24, 2002

A more recent version of this article appeared on July 16, 2002

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Submitted on April 15, 2002
Revised on May 23, 2002
Accepted on May 23, 2002

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, and 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.

^* To whom correspondence should be addressed. 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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