title: Use of Echocardiography in Olmsted County Outpatients With Chest Pain and Normal Resting Electrocardiograms Seen at Mayo Clinic Rochester.
abstract: OBJECTIVE
  To determine how often unnecessary resting echocardiograms that are "not recommended" by clinical practice guidelines are performed in patients with stable chest pain and normal resting electrocardiograms (ECGs).
  
  
  METHODS
  We performed a retrospective search of electronic medical records of all outpatients seen at Mayo Clinic Rochester from January 1, 2010, through December 31, 2013, to identify residents of Olmsted County, Minnesota, with stable chest pain and known or suspected coronary artery disease who underwent resting echocardiography and had normal resting ECGs and no other indication for echocardiography.
  
  
  RESULTS
  Of the 8280 outpatients from Olmsted County who were evaluated at Mayo Clinic Rochester with chest pain, 590 (7.1%) had resting echocardiograms. Ninety-two of these 590 patients (15.6%) had normal resting ECGs. Thirty-three of these 92 patients (35.9%) had other indications for echocardiography. The remaining 59 patients (10.0% of all echocardiograms and 0.7% of all patients) had normal resting ECGs and no other indication for echocardiography. Fifty-seven of these 59 patients (96.6%) had normal echocardiograms. Thirteen of these 59 echocardiograms (22.0%) were "preordered" before the provider (physicians, nurses, physician assistants) visit.
  
  
  CONCLUSIONS
  The overall rate of echocardiography in Olmsted County outpatients with chest pain seen at Mayo Clinic Rochester is low. Only 1 in 10 of these echocardiograms was performed in violation of the class III recommendation in the American College of Cardiology Foundation/American Heart Association guidelines for the management of stable angina. These unnecessary echocardiograms were almost always normal. The rate of unnecessary echocardiograms could be decreased by eliminating preordering.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN. Electronic address: gibbons.raymond@mayo.edu.
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Gibbons
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
authors.forename: Damita
authors.initials: D
authors.lastname: Carryer
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: Hongfang
authors.initials: H
authors.lastname: Liu
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Brady
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; Division of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: J Wells
authors.initials: JW
authors.lastname: Askew
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: David
authors.initials: D
authors.lastname: Hodge
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
authors.forename: Naser
authors.initials: N
authors.lastname: Ammash
authors.affiliation: Nicotine Dependence Center and Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Jon O
authors.initials: JO
authors.lastname: Ebbert
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
authors.forename: Veronique L
authors.initials: VL
authors.lastname: Roger
mesh_terms: D000553:Ambulatory Care / Q000592:standards / Q000706:statistics & numerical data; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis; D004452:Echocardiography / Q000706:statistics & numerical data*; D004562:Electrocardiography / Q000379:methods / Q000706:statistics & numerical data; D057286:Electronic Health Records; D019983:Guideline Adherence; D006801:Humans; D008910:Minnesota; D010346:Patient Care Management / Q000379:methods / Q000592:standards; D017410:Practice Guidelines as Topic; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*