Abstract 13622: Cardiac Practitioners Have Higher Rates of Guideline Adherence for Echocardiography Follow Up in Outpatients with Valvular Disease
Introduction: Attention to resource utilization has led to increased scrutiny on the appropriateness of diagnostic imaging studies. Far less attention has been paid to examining the lack of appropriate follow up studies when tests are abnormal.
Hypothesis: We hypothesize that there will be differences in rates of timely follow-up echocardiography depending on ordering physician specialty, valve lesion, patient age and gender.
Methods: We performed a retrospective cross sectional analysis of consecutive outpatients referred for transthoracic echocardiography from July through December 2008 at a single large academic center. Patients with moderate or greater valvular stenosis or regurgitation were followed to see if they had a subsequent echocardiographic study before or within 30 days after the period recommended by the 2007 ACC Valve Guidelines document.
Results: Of 365 outpatients with at least moderate valve dysfunction, 38(10.4%) were excluded due to reasons which precluded the need for a follow up study (e.g. death, surgery). Of the remaining 327 patients, only 57.8% underwent a follow up echocardiogram within the recommended period. Rates of timely follow-up echocardiography were significantly higher when ordering physicians were cardiologists (64.5%) and cardiovascular surgeons (72.7%) compared with primary care physicians (43.2%) and internists (44.4%, p=0.002). The follow-up rates were significantly different (p<0.01) for aortic stenosis (77.0%), mitral stenosis (66.7%), aortic regurgitation (48.3%), and mitral regurgitation (49.1%). Patients receiving timely follow up echocardiograms were younger (average age 66.1±14.8 years vs 71.2±15.0 years, p=0.002) and more likely to be male (OR=1.79, 95% C.I.=1.12-2.85, p=0.01).
Conclusions: A large minority of patients with at least moderate valve dysfunction do not undergo a follow-up echocardiogram within the guideline recommended period. Higher rates of compliance occurred when followed by cardiac subspecialists and for stenotic valvular conditions.
- © 2011 by American Heart Association, Inc.