U.S. Hospital Use of Echocardiography: Insights From the Nationwide Inpatient Sample
- PMID: 26846948
- DOI: 10.1016/j.jacc.2015.10.090
U.S. Hospital Use of Echocardiography: Insights From the Nationwide Inpatient Sample
Abstract
Background: Increased use of echocardiography (echo) raises questions of whether echo is an overused diagnostic procedure in the United States.
Objectives: This study investigated national trends, practice patterns, and patient outcomes associated with inpatient echo use reported in the Nationwide Inpatient Sample (NIS).
Methods: We identified admission diagnoses most commonly associated with echo use and performed multivariate logistic regression within each diagnosis cohort to assess whether echo use was associated with all-cause inpatient mortality. Secondary analysis was performed within our institution to validate use trends identified in the NIS database.
Results: Between 2001 and 2011, the absolute volume and incidence of echo steadily increased at average annual rates of 3.41% and 3.04%, respectively. In 2010, the use of echo was associated with lower odds of inpatient mortality among hospitalizations for acute myocardial infarction (adjusted odds ratio [OR]: 0.74; 95% confidence interval [CI]: 0.63 to 0.86; p < 0.001), cardiac dysrhythmia (adjusted OR: 0.72; 95% CI: 0.55 to 0.94; p = 0.02), acute cerebrovascular disease (adjusted OR: 0.36; 95% CI: 0.31 to 0.42; p < 0.001), congestive heart failure (adjusted OR: 0.82; 95% CI: 0.72 to 0.94; p = 0.005), and sepsis (adjusted OR: 0.77; 95% CI: 0.70 to 0.85; p < 0.001). In 2010, these 5 diagnoses accounted for 3.7 million hospital admissions (9% of all hospitalizations); however, echo was reported in only 8% of cases. Secondary analysis of imaging practices at our institution confirmed underuse of echo among patients who died during hospitalization for indications identified in the NIS database.
Conclusions: Despite increasing rates of performance, echo may be underused during critical cardiovascular hospitalizations.
Keywords: echocardiography; national trends.
Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Comment in
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Are We Doing Too Many Inpatient Echocardiograms?: The Answer From Big Data May Surprise You!J Am Coll Cardiol. 2016 Feb 9;67(5):512-4. doi: 10.1016/j.jacc.2015.10.091. J Am Coll Cardiol. 2016. PMID: 26846949 No abstract available.
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