Abstract 11291: Focused Cardiac Ultrasound in Place of Repeat Echocardiography: Reliability and Cost Implications
Objectives: We sought to determine the reliability and potential cost savings of using expert focused cardiac ultrasound (eFCU) in place of repeat transthoracic echocardiography (TTE) in selected inpatients.
Background: Rates of repeat echocardiography (two TTEs performed in close proximity) remain high despite attempts by professional societies to curb inappropriate and repeat testing. The healthcare cost of repeat imaging is substantial. Certain findings from handheld ultrasound scans performed by echocardiographers (eFCU) have been shown to correlate well with TTE findings. It therefore may be feasible and cost-effective to use eFCU in place of repeat TTE in certain settings.
Methods: We prospectively enrolled inpatients that had a repeat TTE (prior TTE within 30 days) ordered for the assessments of ventricular function, pericardial effusions, or intravascular volume status. Subjects underwent eFCU in addition to TTE, and results were compared for correlation with the weighted kappa statistic (k). The potential cost savings of using eFCU in place of TTE was modeled both from the perspective of payers (i.e., Medicare) based on reimbursement rates, and providers (i.e., physicians and hospitals) based on purchase price, usage, and depreciation of the devices, as well as cardiologist, sonographer, and transport time for exam performance and interpretation.
Results: Over 45 days, 105 patients were enrolled. The majority of scans were performed for assessment of left ventricular (LV) function and pericardial effusions. eFCU showed excellent correlation with TTE for most parameters including LV systolic function (k = 0.80, p < .001) and the presence and size of pericardial effusions (k = 0.81, p < .001). No clinically significant findings were missed by eFCU. Use of eFCU with this protocol could potentially replace 787 repeat TTEs annually at our institution, leading to an annual cost savings of $456,460 for payers and $88,215 for providers.
Conclusions: Findings from eFCU correlate well with TTE when used in the setting of repeat testing for assessment of ventricular function, pericardial effusion, and volume status. Use of eFCU in place of repeat inpatient TTE may improve the efficiency of imaging resources and decrease healthcare costs.
Author Disclosures: V. Kini: None. N. Mehta: None. J.A. Mazurek: None. V.A. Ferrari: None. P.W. Groeneveld: None. J.N. Kirkpatrick: None.
- © 2014 by American Heart Association, Inc.