Abstract 10982: Point-of-Care Use of Hand-Held Ultrasound Can Significantly Reduce Downstream Testing in Patients With Common Cardiac Conditions
The physical exam (PE) can be unreliable and can decrease the confidence of an examiner in determining if a physical finding is significant and warrants additional testing. We hypothesized that finding no abnormality or a clinically insignificant abnormality on hand-held ultrasound (HHU) at the point-of-care will decrease the probability of ordering a subsequent test and thus potentially reduce overall costs in cardiovascular care.
Methods: Patients with the 5 most common clinical indications for echocardiography at our institution (chest pain or shortness of breath, murmur, stroke, arrhythmia and congenital diseases) underwent PE and HHU by different cardiologists blinded to all information. Based on their findings, they indicated whether the patient needed no further testing or needed to undergo one of the 5 following tests to further clarify the diagnosis: formal echocardiography; stress nuclear scintigraphy, cardiac magnetic resonance imaging, cardiac computed tomography or cardiac catheterization. Technical and professional fees for each test were calculated using institutional charges.
Results: Of the 250 patients examined, 142 had abnormal finding(s) on standard echocardiography. Of these, further testing was suggested in 128 patients (90%) after PE and 129 patients (91%) after HHU (P=1.0). There was a marginal increase in charges of $5,874 after HHU examination based on the type of test ordered. In comparison, of the 108 patients without any abnormalities on standard echocardiography, further testing was suggested in 89 (82%) undergoing PE versus 60 (56%) undergoing HHU (P<0.0001). There was appreciable saving in charges of $43,819 because of the reduction in the number of downstream testing suggested after HHU. The majority of further testing suggested was standard echocardiography in 181 patients having HHU and 207 patients undergoing PE. The number of patients that would have been referred for cardiac catheterization was similar for HHU and PE (7 versus 6, P=1.0).
Conclusion: The ability of HHU to correctly detect normal findings could eliminate the need to obtain further diagnostic testing. HHU can be exceptionally cost effective compared to PE in excluding pathology at the point-of-care.
- © 2013 by American Heart Association, Inc.