Better Methods Required to Optimize Transthoracic Echocardiography Use

Low rate of active change in care resulting from use of transthoracic echocardiography (TTE) indicates a need for a better method to optimize its use, according to an article published in JAMA Internal Medicine.

Researchers from the University of Texas Southwestern Medical Center in Dallas undertook a retrospective review to determine the proportion of TTEs that affected clinical care, defining appropriate and inappropriate use by appropriate use criteria (AUC).

The researchers assessed 535 TTEs that were performed at an academic center. Two cardiologists blinded to the clinical impact and two blinded to the AUC classified the TTEs. There were three categories: active change in care, continuation of current care, and no change in care.

The results showed that overall 31.8 percent of the TTEs resulted in a change of care; 46.9 percent continued care; and there was no change in care for 21.3 percent. The cardiologists deemed that 91.8 percent of the TTEs were appropriate, only 4.3 percent were inappropriate, and 3.9 percent were uncertain.

“We detected no statistically significant difference between appropriate and inappropriate TTEs in the proportion of TTEs that led to active change in care (32.2 percent versus 21.7 percent),” the authors wrote.

The authors concluded that given the low number of times that active care was changed due to the TTE findings, despite most of the TTEs being appropriate, there needs to be a better method to use the test in order to keep costs down while providing high-quality care.