Congratulations to Dr. Quinn Pack, Assistant Professor of Medicine, and his team on the recent publication of “Association Between Inpatient Echocardiography Use and Outcomes in Adult Patients With Acute Myocardial Infarction” in JAMA Internal Medicine. The objective of this paper was to examine the association between risk-standardized hospital rates of transthoracic echocardiography and outcomes.
“This paper challenges the idea that everyone with a heart attack needs an echocardiogram, and that, particularly at high use hospitals, it may be possible to reduce the number of studies that are performed,” says Dr. Pack. “This could potentially lead to increased savings and greater value of hospital-based care.” As a practicing cardiologist, Dr. Pack often sees echocardiograms (heart ultrasound studies) ordered on patients where, even before the pictures are taken, it is pretty clear that the test is unlikely to yield any new diagnostic information. More importantly, there is prior research showing that as few as 30% of echocardiograms actually affect clinical care.
“As a result, we wanted to see if the use of echocardiography would lead to improved patient outcomes,” Dr. Pack adds. To do this, the group evaluated about 400 hospitals and 100,000 patients with a heart attack and correlated hospital outcomes (rates of inpatient mortality, cost, length of stay and readmission) with how frequently the hospital used echocardiography. They found no differences in rates of mortality or readmission when comparing hospitals with echo rates of about 85% (top quartile) compared to hospitals with echo rates of about 55% (bottom quartile), but top quartile hospitals spent more money and had longer lengths of stay.
“This paper should encourage clinicians to be careful and thoughtful when ordering an echocardiogram,” concludes Dr. Pack. “In general, echocardiography should not be done just to complete a routine or protocol, but rather should be prompted by an honest clinical question that needs answering. Such thoughtful testing may also benefit patients by reducing overall health care costs.”
Dr. Pack co-authored this paper with UMMS-Baystate faculty and staff: Aruna Priya, MA, MSc; Tara Lagu, MD, MPH; Penelope Pekow, PhD; JP Schilling, MD; William Hiser, MD; and Peter K. Lindenauer, MD, MSc, MHM. Read the abstract here.
Citation: JAMA Intern Med. 2019 Jun 17. doi: 10.1001/jamainternmed.2019.1051.