title: Appropriate use and clinical impact of transthoracic echocardiography.
abstract: OBJECTIVE
  Transthoracic echocardiography (TTE) accounts for almost half of all cardiac imaging services and is a widely available and versatile tool. Appropriate use criteria (AUC) for echocardiography were developed to improve patient care and health outcomes. Prior studies have shown that most TTEs are appropriate by AUC. However, the associations among TTE, AUC, and their clinical impact have not been well explored.
  
  
  OBJECTIVE
  To describe the proportion of TTEs that affect clinical care in an academic medical center overall and in subgroups defined as appropriate and inappropriate by AUC.
  
  
  METHODS
  Retrospective review of medical records from 535 consecutive TTEs at an academic medical center was performed. The TTEs were classified according to 2011 AUC by 2 cardiologists blinded to clinical impact and were assessed for clinical impact by 2 cardiologists blinded to AUC. Clinical impact was assigned to 1 of the following 3 categories: (1) active change in care, (2) continuation of current care, or (3) no change in care.
  
  
  METHODS
  Five hundred thirty-five patients undergoing TTE.
  
  
  METHODS
  Transthoracic echocardiography. MAIN OUTCOMES AND MEASURES Prevalence of appropriate, inappropriate, and uncertain TTEs and prevalence of clinical impact subcategories.
  
  
  RESULTS
  Overall, 31.8% of TTEs resulted in an active change in care; 46.9%, continuation of current care; and 21.3%, no change in care. By 2011 AUC, 91.8% of TTEs were appropriate; 4.3%, inappropriate; and 3.9%, uncertain. We detected no statistically significant difference between appropriate and inappropriate TTEs in the proportion of TTEs that led to active change in care (32.2% vs 21.7%; P= .29).
  
  
  CONCLUSIONS
  Although 9 in 10 TTEs were appropriate by 2011 AUC, fewer than 1 in 3 TTEs resulted in an active change in care, nearly half resulted in continuation of current care, and slightly more than 1 in 5 resulted in no change in care. The low rate of active change in care (31.8%) among TTEs mostly classified as appropriate (91.8%) highlights the need for a better method to optimize TTE utilization to use limited health care resources efficiently while providing high-quality care.
authors.affiliation: Department of Medicine, The University of Texas Southwestern Medical Center, Dallas.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Matulevicius
authors.forename: Anand
authors.initials: A
authors.lastname: Rohatgi
authors.forename: Sandeep R
authors.initials: SR
authors.lastname: Das
authors.forename: Angela L
authors.initials: AL
authors.lastname: Price
authors.forename: Andres
authors.initials: A
authors.lastname: DeLuna
authors.forename: Sharon C
authors.initials: SC
authors.lastname: Reimold
mesh_terms: D000046:Academic Medical Centers; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D015995:Prevalence; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology; D014600:Utilization Review / Q000379:methods*