J Am Soc Echocardiogr. 2021 Jul 17:S0894-7317(21)00596-4. doi: 10.1016/j.echo.2021.07.008. Online ahead of print.
BACKGROUND: We retrospectively evaluated the impact of UEA use in the first TTE, regardless of the baseline image quality, on the number of repeat TTEs and length of stay (LOS) during a HF admission.
METHODS: There were 9,115 HF admissions associated with an admission TTE over a 4 year period (5,337 men; mean age 67.6 ± 15.0 years). Patients were grouped into those who received a UEA (contrast group) in the first TTE and those who did not (non-contrast group). Repeat TTEs were classified as justified if performed for concrete clinical indications during hospitalization.
RESULTS: In the 9,115 admissions for HF (n = 5,600 contrast group, 3,515 non-contrast group) 927 patients had repeat TTEs (n = 505 contrast group, 422 non-contrast group), which was considered justified in 823 patients. Of the 104 patients who had unjustified repeat TTEs, 80 belonged to the non-contrast group (76.7%) and 24 belonged to the contrast group. Also, UEA usage increased from 50.4% in 2014 to 74.3%, and the rate of unjustified repeats decreased from 1.3% to 0.9%. The rates of unjustified repeat TTE were 2.3% and 0.4% (non-contrast and contrast groups, respectively), and patients in the contrast group were less likely to receive an unjustified repeat echo (OR = 0.18, 95% CI: 0.12 to 0.29, p < 0.0001). The mean LOS was significantly lower in the contrast group (9.5 ± 10.5 days versus 11.1 ± 13.7 days). The use of UEA in the first TTE was also associated with a reduced LOS (linear regression, β1 = -0.47, p = 0.036), with 20% lower odds for odds of prolonged (>6 days) LOS.
CONCLUSIONS: The routine use of UEA in the first TTE for HF irrespective of image quality is associated with reduced unjustified repeat TTE testing and may reduce LOS during an index HF admission.