Increased use of echocardiography in patients with acute MI associated with longer LOS, higher costs but no mortality benefit

Reference

Pack QR, Priya A, Lagu T et al. Association between inpatient echocardiography use and outcomes in adult patients with acute myocardial infarction. JAMA Intern Med 2019;179:1176-1185.

Synopsis

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).