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Abstract 18762: Adherence to Appropriate Use Criteria for Transesophageal Echocardiography Use in Suspected Infective Endocarditis
- Christopher M Bianco,
- Ashley E Burch,
- Yara L Cameron,
- Deepinder S Grewal,
- Singh P Puneet,
- Samuel F Sears and
- Rajasekhar Nekkanti
Circulation Volume 134, Issue suppl_111 November 2016

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Introduction: AHA appropriate use criteria (AUC) and valvular heart disease guidelines help direct appropriate utilization of transesophageal echocardiography (TEE) in suspected infective endocarditis (IE). A limitation of previous literature examining TEE AUC adherence was underrepresentation of studies performed in suspected IE.Hypothesis: We hypothesized that TEE was often inappropriately utilized in the evaluation of low pretest probability patients, defined as those without high risk predisposing factors and a low modified duke score following quality TTE.Methods: Clinical information retrieved from the electronic medical record was used to retrospectively analyze 229 consecutive TEE studies performed in the evaluation of suspected IE between 7/1/2013-12/31/2015 at a large academic center.Results: Inappropriate TEE use was determined in 14% of studies. All inappropriate studies failed to show TEE evidence of IE. About two thirds (67%) of inappropriate studies were ordered by three groups - Internal Medicine (35%), Family Medicine (16%), and Medical Intensive Care Unit (16%). One third (33%) of all inappropriate studies were performed in evaluation of bacteremia with a microorganism not typically causing IE.Conclusions: In conclusion, a sizable minority of inappropriate TEE studies were performed in low risk patients. No evidence of IE was found on any of the inappropriate TEEs, thus reinforcing the inappropriate nature of these studies. Three subspecialty groups were responsible for the majority of inappropriate studies. The most common reason for inappropriate TEE use was in evaluation of bacteremia with an atypical IE pathogen.
Electrocardiographic Changes and Arrhythmias in Hospitalized Patients With COVID-19
Circulation: Arrhythmia and Electrophysiology Volume 13, Issue 101 October 2020

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Randomized Clinical Trial to Evaluate an Atrial Fibrillation Stroke Prevention Shared Decision‐Making Pathway
- Paul J. Wang,
- Ying Lu,
- Kenneth W. Mahaffey,
- Amy Lin,
- Daniel P. Morin,
- Samuel F. Sears,
- Mina K. Chung,
- Andrea M. Russo,
- Bryant Lin,
- Jonathan Piccini,
- Mellanie True Hills,
- Caroline Berube,
- Krishna Pundi,
- Tina Baykaner,
- Gotzone Garay,
- Karma Lhamo,
- Eli Rice,
- Idean A. Pourshams,
- Rushil Shah,
- Paul Newswanger,
- Katie DeSutter,
- Julio Cesar Nunes,
- Michelle A. Albert,
- Kevin A. Schulman,
- Paul A. Heidenreich,
- T. Jared Bunch,
- Lee M. Sanders,
- Mintu Turakhia,
- Abraham Verghese and
- Randall S. Stafford
Journal of the American Heart Association Volume 12, Issue 37 February 2023

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BackgroundOral anticoagulation reduces stroke and disability in atrial fibrillation (AF) but is underused. We evaluated the effects of a novel patient‐clinician shared decision‐making (SDM) tool in reducing oral anticoagulation patient's decisional conflict as compared with usual care.Methods and ResultsWe designed and evaluated a new digital decision aid in a multicenter, randomized, comparative effectiveness trial, ENHANCE‐AF (Engaging Patients to Help Achieve Increased Patient Choice and Engagement for AF Stroke Prevention). The digital AF shared decision‐making toolkit was developed using patient‐centered design with clear health communication principles (eg, meaningful images, limited text). Available in English and Spanish, the toolkit included the following: (1) a brief animated video; (2) interactive questions with answers; (3) a quiz to check on understanding; (4) a worksheet to be used by the patient during the encounter; and (5) an online guide for clinicians. The study population included English or Spanish speakers with nonvalvular AF and a CHA₂DS₂‐VASc stroke score ≥1 for men or ≥2 for women. Participants were randomized in a 1:1 ratio to either usual care or the shared decision‐making toolkit. The primary end point was the validated 16‐item Decision Conflict Scale at 1 month. Secondary outcomes included Decision Conflict Scale at 6 months and the 10‐item Decision Regret Scale at 1 and 6 months as well as a weighted average of Mann–Whitney U‐statistics for both the Decision Conflict Scale and the Decision Regret Scale. A total of 1001 participants were enrolled and followed at 5 different sites in the United States between December 18, 2019, and August 17, 2022. The mean patient age was 69±10 years (40% women, 16.9% Black, 4.5% Hispanic, 3.6% Asian), and 50% of participants had CHA₂DS₂‐VASc scores ≥3 (men) or ≥4 (women). The primary end point at 1 month showed a clinically meaningful reduction in decisional conflict: a 7‐point difference in median scores between the 2 arms (16.4 versus 9.4; Mann–Whitney U‐statistics=0.550; P=0.007). For the secondary end point of 1‐month Decision Regret Scale, the difference in median scores between arms was 5 points in the direction of less decisional regret (P=0.078). The treatment effects lessened over time: at 6 months the difference in medians was 4.7 points for Decision Conflict Scale (P=0.060) and 0 points for Decision Regret Scale (P=0.35).ConclusionsImplementation of a novel shared decision‐making toolkit (afibguide.com; afibguide.com/clinician) achieved significantly lower decisional conflict compared with usual care in patients with AF.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT04096781.

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Abstract 18762: Adherence to Appropriate Use Criteria for Transesophageal Echocardiography Use in Suspected Infective Endocarditis

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Electrocardiographic Changes and Arrhythmias in Hospitalized Patients With COVID-19

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Randomized Clinical Trial to Evaluate an Atrial Fibrillation Stroke Prevention Shared Decision‐Making Pathway

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