Clinical Importance of Transthoracic Echocardiography with Direct Input from Treating Physicians

Background: The recent report that appropriately performed echocardiographic examinations result in active changes in management in only one third of patients has challenged the validity of current appropriate use criteria. Limited information exists about the clinical importance of transthoracic echocardiography (TTE) to guide management and rule out important alternative pathology.

Methods: The clinical impact of inpatient TTE performed at the Mayo Clinic over a 20-week period between October 14, 2013, and March 3, 2014, was investigated. Studies were included if they were ordered within 72 hours of admission, and treating physicians participated in a real-time survey regarding the clinical importance of TTE. Appropriate use was determined by two independent investigators, with differences adjudicated by a third investigator. Clinical impact was derived from physicians' survey responses and independently confirmed by chart review.

Results: Of the 539 transthoracic echocardiographic examinations included in this study, 512 (95%) were appropriate, 16 (3%) may be appropriate and 11 (2%) rarely appropriate. Although only 48% of participating physicians actively changed management on the basis of findings on TTE, 97% responded that TTE answered their clinical questions, and 95% would still order TTE in similar clinical contexts.

Conclusions: Most early inpatient transthoracic echocardiographic studies at our institution were appropriate and answered specific clinical questions important for management decisions in the opinion of the treating physician. Confirming a plan of care already in place and ruling out alternative pathology may be as important clinically as uncovering new findings or changing management.