| Abstract [eng] |
Transthoracic echocardiography is one of the most commonly performed non-invasive cardiac imaging techniques due to its accessibility, safety, and rapid execution. However, in recent years, increasing attention has been drawn to the potential overuse of this and other imaging methods - particularly when examinations are performed without obvious clinical necessity, in the absence of clear indications, or when the patient’s condition remains unchanged. Such practices not only fail to add diagnostic value but also contribute to the overload of diagnostic services. Therefore, the excessive utilisation of transthoracic echocardiography may lead to the inefficient use of healthcare resources. Objective: To assess the appropriateness of using transthoracic echocardiography at Vilnius University Hospital Santaros Clinics, using the modified Appropriate Use Criteria by the American College of Cardiology and the American Heart Association, to evaluate the appropriateness of routine transthoracic echocardiography examinations, as well as the quality of the studies and referral documentation. Methods: A retrospective analysis was conducted on anonymized data from 600 consecutive patients who underwent at least one transthoracic echocardiography between March 1 and March 15, 2021. The analysis included evaluation of study indications, the setting of examination (inpatient vs. outpatient), the number of repeat studies, follow-up duration, diagnostic quality, and relevance of the refferal. Results: The indications of transthoracic echocardiography tests were classified as appropriate, inappropriate or uncertain in 80 %, 14.7 % and 5.3 %, respectively. In the outpatient setting, 26.2 % of the studies were either uncertain or inappropriate, compared to just 3.1 % of such use in the inpatient group (p < 0.05). At least one repeat transthoracic echocardiography was performed in 61.2 % of patients, with 24.9 % of these studies found to be inappropriate. A strong positive correlation was observed between the number of repeat and inappropriate studies (r = 0.85, p < 0.0001). There were 73 (53.3%) tests assessed as good quality (>70%) and 39 (28.5%) tests as medium quality (50–70%). 34.7 % of referrals were non-informative, especially when the consulting physician performed the study himself. Conclusions: In most cases transthoracic echocardiography is used appropriately, however this study revealed notable overuse — particularly in the outpatient setting and during long-term follow-up, through repeat and unnecessary testing. To optimize the use of transthoracic echocardiography, it is essential to follow established appropriateness criteria, improve the informativeness of referrals, and support more individualized clinical decision-making. |
