Impact of a specific echocardiographic report comment regarding endocarditis prophylaxis on compliance with American Heart Association recommendations.
BACKGROUND
There is substantial underuse and overuse of antibiotic prophylaxis. Current American Heart Association (AHA) recommendations are heavily dependent on echocardiographic data that may not be familiar to referring physicians. We sought to determine the impact of a specific prophylaxis report comment on compliance with AHA recommendations.


RESULTS
Using a standardized electronic reporting system, physicians interpreting approximately 50% of echocardiograms included a concluding comment classifying endocarditis risk and stating whether prophylaxis was indicated. The remaining reports were identical in format/content but did not include such comments. Of 1461 eligible outpatients during a 6-month period, 969 (66.3%) responded to a mail survey regarding prophylaxis instructions. Overall, 50% reported taking prophylaxes. Compliance with AHA recommendations was greater among those with a comment (73.2% versus 65.4% for those receiving versus those not receiving comments, respectively; P=0.011), with particular improvement among moderate-risk patients (69.5% versus 59.9%, P=0.024).


CONCLUSIONS
An echocardiographic report statement regarding endocarditis risk and need for prophylaxis is a simple low-cost intervention that improves compliance with AHA recommendations. Interpreting physicians should become familiar with AHA recommendations and include a concluding statement addressing prophylaxis.
Sanders
Gregory P
GP
Department of Medicine vascular, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA.
Yeon
Susan B
SB
Grunes
Jason
J
Seto
Todd B
TB
Manning
Warren J
WJ
D000328:Adult; D000368:Aged; D000572:American Heart Association; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D004452:Echocardiography; D004696:Endocarditis / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012017:Referral and Consultation