Echo-related studies garner attention at the AHA Scientific Sessions
AHA Daily News: A combination of nano-sized bubbles and ultrasound can deliver drugs to treat infective endocarditis by disrupting the biofilm that typically shields infected cardiac tissue from antibiotics. ASE member Satoshi Nakatani, MD, PhD, professor in the department of functional diagnostics at Osaka University Graduate School of Medicine in Japan, explained “endocarditis is refractory to treatment due to a biofilm which protects the bacterial vegetation from antibiotics and other external materials. In humans, endocarditis is a lethal disease. We want antibiotics to penetrate into the bacterial vegetation more easily in order to reduce the time and difficulty of treatment. That is why we thought of ultrasound.”
Health Imaging: A utilization management program modeled on the American College of Cardiology Foundation’s Appropriate Use Criteria was shown to prevent unnecessary imaging exams and resulted in a 12 percent reduction in the likelihood of follow-up tests, including myocardial perfusion imaging and cardiac CT scans. The study “Utilization Management Reduces Repeated Outpatient Cardiovascular Imaging” (Abstract 14699) was presented as a poster on Sunday, November 4. ASE partnered with the ACC on the appropriate use criteria for echocardiography.
PSL Group: A study designed to evaluate the application of the Appropriate Use Criteria (AUC) for Echocardiography published by the ACC, ASE and other societies in 2011, determined that one-third of repeat transthoracic echocardiography (TTE) tests in a tertiary care ical center were inappropriate according to the criteria. The study “Appropriate Use of Inpatient Repeat Echocardiography in a Tertiary Care Center” was presented as a poster on Sunday, November 4 (Abstract 19632).Anu Vellanki, MD, University of Massachusetts Medical School, and colleagues evaluated written requests for 500 consecutive inpatient TTEs over a 1-month period in 2012 and examined the echocardiography database to determine if a TTE had been perfor within 1 year. Overall, 131 (26%) of the TTEs were repeat studies; 107 patients had a previous TTE repeated within the last 6 months, while 24 patients had a previous TTE in the last year. Per the AUC, forty-nine percent of the repeat echocardiograms were dee appropriate, 34% inappropriate and 17% uncertain. The three main indications for inappropriate TTE were heart failure, syncope, and pericardial effusion. Thirty percent of the repeat TTEs were ordered by cardiologists and 70% were ordered by non-cardiology providers.
The study concluded that in an effort to reduce inappropriate, repeat TTEs, knowledge of prior TTE data and incorporation of AUC into order entry mechanisms should occur. “The entire clinical picture and knowledge of the presence and results of prior imaging should be taken account when contemplating repeat TTE,” said Dr. Vellanki. “In an effort to reduce inappropriate imaging, AUC criteria should be incorporated into order entry mechanisms in a fully functional electronic ical record in order to help guide providers decisions on ordering echocardiography in the inpatient setting.”