Implementation of echocardiographic contrast agents into clinical practice: a United Kingdom National Health Service Survey on behalf of the British Society of Echocardiography.
OBJECTIVE
The administration of echocardiographic contrast agents has been shown to improve accuracy and be cost-effective in patients with suboptimal endocardial definition. We sought to investigate the implementation of contrast agents in clinical practice.


RESULTS
An electronic questionnaire was devised to determine the use of contrast ultrasound agents in clinical practice and sent electronically to echocardiography departments at each national health service hospital within the UK. Out of 198, 107 departments responded (54%). Out of 673,121 echocardiograms, 25,834 (3.8%) were performed with contrast. Out of 551 echocardiography machines, 358 (65%) were suitable for contrast use. Of the sonographers, out of 711, 112 (15.8%) could perform i.v. cannulation and 42 (5.9%) could administer contrast independently. The median time for an echocardiographic examination was 30 min (inter-quartile range 30-45 min). Significant predictors of contrast use were the presence of a consultant cardiologist with subspecialty training in echocardiography (odds ratio 8.7, P = 0.004), the presence of a stress echocardiography service (odds ratio 2.3, P = 0.004), and the presence of a physician during the day (odds ratio 3.0, P = 0.04). Reasons for impediment in administering contrast were staff training (34.6%), extra time required for a contrast study (29.9%), and the expense of contrast (18.7%).


CONCLUSIONS
The use of echocardiographic contrast agents within routine echocardiographic practice in the UK is limited to <4% of all transthoracic echocardiographic studies. Major barriers to the implementation of contrast use are the absence of cardiac imaging specialists directly supervising echocardiography departments and the training of sonographers to independently administer contrast.
Department of Cardiology and Echocardiography Laboratory, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
Sanjeev
S
Bhattacharyya
Rajdeep
R
Khattar
Guy
G
Lloyd
Roxy
R
Senior
D016507:Cardiology Service, Hospital; D003287:Contrast Media / Q000191:economics; D003362:Cost-Benefit Analysis; D004452:Echocardiography / Q000379:methods / Q000706:statistics & numerical data*; D025401:Echocardiography, Stress / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D012955:Societies, Medical; D013222:State Medicine; D011795:Surveys and Questionnaires; D006113:United Kingdom
D003287:Contrast Media