title: The association of abnormal findings on transthoracic echocardiography with 2011 Appropriate Use Criteria and clinical impact.
abstract: Transthoracic echocardiography (TTE) Appropriate Use Criteria (AUC) were developed to promote high-value care. We describe the prevalence of clinically significant abnormal TTE findings overall and in subgroups defined by appropriate and inappropriate AUC, and their association with clinical impact. 548 consecutive TTEs at an academic medical center were retrospectively reviewed for AUC, clinical impact, and TTE abnormalities. TTE reports within 1 year of the index TTE were reviewed to determine if abnormalities were new, unchanged, or resolved. Clinical impact was classified into no change, active change, or continuation of care. 91% of TTEs were appropriate, 5% were inappropriate, and 4% were uncertain by AUC. 46% of all TTEs and 57% of first-time TTEs had no significant TTE abnormalities. Appropriate TTEs had a higher prevalence of ≥1 TTE abnormality than inappropriate TTEs (56 vs. 33%, p = 0.029). Among repeat TTEs, 72 % had ≥1 TTE abnormality, however only 25% had a new abnormality. The prevalence of a new abnormality was similar between inappropriate and appropriate repeat TTEs (25 vs. 26%, p = 1.0). The prevalence of ≥1 abnormality was similar between TTEs that resulted in active change and no change in care (70 vs. 64%, p = 0.06). Although most TTEs were appropriate as defined by AUC, the majority had no significant abnormalities. Although most TTEs were appropriate by AUC, >50% of all TTEs and 25% of repeat TTEs had no significant abnormalities. Appropriate TTEs had a higher prevalence of abnormalities, however the prevalence of abnormalities was similar between TTEs that resulted in active change versus no change in care.
authors.affiliation: Department of Medicine, University of Texas Southwestern Medical Center, 5909 Harry Hines Boulevard, Dallas, TX, 75390-9047, USA.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Koshy
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: Nicholas
authors.initials: N
authors.lastname: Reimold
authors.forename: Kyle
authors.initials: K
authors.lastname: Willett
authors.forename: Sharon C
authors.initials: SC
authors.lastname: Reimold
authors.forename: Susan A
authors.initials: SA
authors.lastname: Matulevicius
mesh_terms: D000046:Academic Medical Centers / Q000592:standards; D000328:Adult; D000368:Aged; D004452:Echocardiography / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D008297:Male; D000069342:Medical Overuse / Q000517:prevention & control; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology