Abstract 10786: Appropriateness of Stress Echocardiograms in Patients Admitted to a Chest Pain Service
Introduction: Many protocols have been established to rule out acute coronary syndrome (ACS) in low- to intermediate-risk patients presenting with chest pain. Our tertiary-care hospital developed an observation-stay Chest Pain (CP) Service run by cardiology fellows and teaching faculty to provide higher-quality and more effective care of these patients, improving patient safety and length of stay. We frequently use stress echocardiography (echo) due to its efficiency and rapid result.
Objectives: The goal of this study was to identify overuse or misuse of stress echo by our service, based on the published ACCF/ASE 2008 Appropriateness Criteria (AC) for Stress Echocardiography.
Methods: A 9-month retrospective analysis of our CP Service was performed. Baseline patient characteristics, pretest probability of CAD, and length of stay were recorded. Appropriateness of each stress echo was determined using AC category “Detection of CAD: Symptomatic (evaluation of chest pain syndrome or anginal equivalent).” Inappropriate use was defined as stress echo in a patient with a low pretest probability of CAD, an interpretable ECG and the ability to exercise.
Results: Of 459 patients admitted, 300 (65%) underwent stress echo and 67 (15%) myocardial perfusion imaging. Patients undergoing stress echo had a shorter length of stay versus those undergoing nuclear study (0.9 days vs. 1.7 days, p<0.001). Eighty-five percent of stress echos were deemed appropriate per published criteria. Inappropriate use of stress echo was seen more in younger patients (median 46 years vs. 50 years, p<0.001) and females (77.3% vs. 47.7%, p<0.001). There were abnormal results in five (11.4%) of the inappropriate studies; all but one were confirmed as false positives via cardiac catheterization.
Conclusions: In a Cardiology CP Service designed to quickly and efficiently rule out ACS, the majority of stress echocardiograms were ordered appropriately (no evidence of misuse or overuse), with the exception of younger females who have a low pretest probability of CAD.
- © 2010 by American Heart Association, Inc.