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Routine Use of Contrast on Admission Transthoracic Echocardiography for Heart Failure Reduces the Rate of Repeat
K Charlotte Lee1, Shizhen Liu2, Patrick Callahan2
1Georgia Institute of Technology, Atlanta, Georgia; Piedmont Heart Institute, Atlanta, Georgia.
Insights
Routine use of ultrasound enhancing agents (UEA) in initial transthoracic echocardiograms (TTE) for heart failure (HF) patients reduces repeat testing and shortens hospital stays. This approach improves efficiency and patient outcomes during HF admissions.
Area of Science:
- Cardiology
- Medical Imaging
- Health Services Research
Background:
- Heart failure (HF) admissions often require transthoracic echocardiograms (TTE) for diagnosis and management.
- The utility of ultrasound enhancing agents (UEA) in initial TTEs for HF patients, regardless of baseline image quality, is under investigation.
- Optimizing TTE protocols may reduce healthcare resource utilization and improve patient flow.
Purpose of the Study:
- To evaluate the impact of using UEA in the first TTE during HF admissions.
- To assess the effect of UEA on the number of repeat TTE examinations and length of stay (LOS).
- To determine if UEA use influences the rate of unjustified repeat TTEs.
Main Methods:
- Retrospective analysis of 9,115 heart failure admissions with initial TTE examinations over a 4-year period.
- Patients were categorized into groups receiving UEA (contrast group) or not (noncontrast group) in their first TTE.
- Repeat TTEs were classified as justified or unjustified based on clinical indications.
Main Results:
- UEA use was associated with a significantly lower rate of unjustified repeat TTEs (0.4% vs 2.3% in noncontrast group; OR, 0.18).
- Patients receiving UEA had a shorter mean length of stay (LOS) (9.5 days vs 11.1 days).
- Routine UEA use correlated with reduced odds of prolonged LOS (>6 days).
Conclusions:
- Routine use of UEA in the initial TTE for HF patients is linked to decreased unjustified repeat testing.
- Employing UEA in the first TTE may lead to a reduction in LOS during index HF admissions.
- This strategy offers potential benefits for healthcare efficiency and patient management in heart failure care.
Background:
The authors retrospectively evaluated the impact of ultrasound enhancing agent (UEA) use in the first transthoracic echocardiographic (TTE) examination, regardless of baseline image quality, on the number of repeat TTEs and length of stay (LOS) during a heart failure (HF) admission.
Methods:
There were 9,115 HF admissions associated with admission TTE examinations over a 4-year period (5,337 men; mean age, 67.6 ± 15.0 years). Patients were grouped into those who received UEAs (contrast group) in the first TTE study and those who did not (noncontrast group). Repeat TTE examinations were classified as justified if performed for concrete clinical indications during hospitalization.
Results:
In the 9,115 admissions for HF (5,600 in the contrast group, 3,515 in the noncontrast group), 927 patients underwent repeat TTE studies (505 in the contrast group, 422 in the noncontrast group), which were considered justified in 823 patients. Of the 104 patients who underwent unjustified repeat TTE studies, 80 (76.7%) belonged to the noncontrast group and 24 to the contrast group. Also, UEA use increased from 50.4% in 2014 to 74.3%, and the rate of unjustified repeat studies decreased from 1.3% to 0.9%. The rates of unjustified repeat TTE imaging were 2.3% and 0.4% (in the noncontrast and contrast groups, respectively), and patients in the contrast group were less likely to undergo unjustified repeat examinations (odds ratio, 0.18; 95% CI, 0.12-0.29; P < .0001). The mean LOS was significantly lower in the contrast group (9.5 ± 10.5 vs 11.1 ± 13.7 days). The use of UEA in the first TTE study was also associated with reduced LOS (linear regression, β1 = -0.47, P = .036), with 20% lower odds for odds of prolonged (>6 days) LOS.
Conclusions:
The routine use of UEA in the first TTE examination for HF irrespective of image quality is associated with reduced unjustified repeat TTE testing and may reduce LOS during an index HF admission.
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