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Effect of a Reminder Statement on Echocardiography Reports on Referrals for Implantable Cardioverter-Defibrillators
Moulin Chokshi1, Robert L McNamara1, Yasotha Rajeswaran2
1Section of Cardiology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
Insights
Adding a simple reminder to echocardiogram reports significantly increased electrophysiology referrals for implantable cardioverter-defibrillators (ICDs). This intervention also showed a trend toward more ICD implantations in eligible patients, improving guideline adherence.
Area of Science:
- Cardiology
- Medical Informatics
Background:
- Implantable cardioverter-defibrillators (ICDs) are recommended for primary prevention in patients with low ejection fraction (EF ≤ 35%), a Class I indication.
- Despite clear guidelines, the utilization of ICDs for primary prevention remains suboptimal.
Purpose of the Study:
- To evaluate if a reminder statement in echocardiogram reports improves adherence to ICD implantation guidelines.
- To assess the impact of echocardiogram report reminders on electrophysiology (EP) referrals and ICD implantation rates.
Main Methods:
- A retrospective chart review was conducted comparing a reminder period (January-June 2013) with a control period (March-August 2012).
- Echocardiogram reports for patients with EF ≤ 35% included an automated reminder during the intervention period.
- Outcomes measured included EP referral within 6 months of echo and ICD implantation within 6 months of EP referral.
Main Results:
- Electrophysiology referrals increased significantly in the reminder period (68%) compared to the control period (51%), p=0.03.
- Physician-patient discussions regarding ICD therapy also rose significantly in the reminder period (71% vs 54%, p=0.02).
- ICD implantation rates showed a trend towards increase in the reminder period (52% vs 38%, p=0.11).
Conclusions:
- An automated reminder in echocardiogram reports effectively improved EP referrals for patients with low ejection fraction.
- This simple intervention demonstrated a positive trend in ICD implantation, suggesting a viable strategy to enhance guideline adherence.
Abstract:
Numerous trials show the benefit of implantable cardioverter-defibrillators (ICDs) for primary prevention in patients with low ejection fraction (EF), a class I indication. However, underutilization is well documented. We retrospectively reviewed charts to see whether placing a reminder statement into echocardiogram reports for appropriate patients increased adherence to guidelines. From January through June 2013, a brief reminder of the ICD guidelines was automatically inserted into echocardiogram reports with EF ≤ 35% (reminder period). Charts were reviewed to determine if these patients (1) were referred to Electrophysiology (EP) within 6 months of the index echo and (2) received an ICD within 6 months of EP referral. Chart review of all patients who had an echocardiogram performed between March and August 2012 with an EF ≤ 35% provided a control period. More patients were referred to EP in the reminder period compared with control period, 68% (54 of 80) versus 51% (53 of 104), p = 0.03. There was also a higher rate of discussions in the reminder period between patients and physicians about ICD therapy (71% vs 54%, p = 0.02). Among patients appropriate for ICD, 52% of patients during the reminder period received an ICD versus 38% of patients during the control period (p = 0.11). A simple reminder statement on echocardiography reports led to a significant improvement in appropriate EP referrals and a trend toward increased ICD implantation in appropriate patients.
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