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Question clinique
Is use of inpatient echocardiography in patients hospitalized with acute myocardial infarction associated with better outcomes?
L’Essentiel
Hospitals vary in their rates of inpatient echocardiography use for patients hospitalized with acute myocardial infarction (AMI). Higher rates of echocardiography are associated with longer lengths of stay (LOS) and higher costs but there is no association with mortality or readmission rates. Judicious use of echocardiography, reserved for cases where findings can change management, should be considered. 2b
Référence
Plan de l'etude: Cohort (retrospective)
Financement: Government
Cadre: Inpatient (any location)
Sommaire
Using a database that represents 397 US hospitals, these investigators identified 98,999 patients discharged with a principal diagnosis of AMI during a one-year period from January to December 2014. Approximately 60% of the cohort were men, mean age was 67 years, and 70% underwent at least 1 transthoracic echocardiogram during their AMI hospitalization. Patients who had an echocardiogram were more likely to have heart failure, pulmonary disease, receive intensive care services, and have nuclear imaging studies. Risk-standardized echocardiography rates varied across hospitals, with a rate of 54% in the lowest quartile hospital and 83% in the highest quartile. The strongest predictor of having an echocardiogram done was the hospital to which the patient was admitted. After adjusting for patient demographics, comorbidities, and hospital characteristics, there were no differences in inpatient mortality (OR 1.02, 95% CI 0.88-1.19) or 3-month readmission (OR 1.01, 95% CI 0.93-1.10), when comparing patients treated at hospitals with the highest and lowest quartile of echocardiography use. Patients in hospitals in the highest quartile had a longer LOS (0.23 days, 95% CI 0.03-0.41, p=.01) and higher cost per admission ($3164, 95% CI $1843-$4485, p<.001).
Reviewer
Nita Shrikant Kulkarni, MD
Assistant Professor in Hospital Medicine
Northwestern University
Chicago, IL
Commentaires
Consequences of imaging technology
The relevance of this information shows that imaging, without a clinical indication, can have adverse outcomes. In this situation, it is an extended hospital stay, with risk such as acquiring and multi-resistant infection. I am reminded of the diagnostic acronym, VOMIT: victim of modern imaging technology. Clinical judgement should select imaging for where it can help managment.
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