health

Cardiologists take issue with study on echocardiogram overuse

Some physicians reject the implication that the test is over-ordered because the screenings often don’t result in changes in care.

By Marcia Frellick amednews correspondent — Posted Aug. 7, 2013

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

The American College of Cardiology interprets results of a new study on use of echocardiograms differently from the University of Texas Southwestern researchers who put it together.

The study appeared online July 22 in JAMA Internal Medicine (link). Authors say that because transthoracic echocardiography results in no change in care nearly 20% of the time, and only one in three screenings results in an active care change, some of the money spent on the tests could be used better elsewhere.

“Everything doesn’t result in a change,” said Eugene Sherman, MD, chair of ACC’s advocacy steering committee.

He gives an example of classic echo use: A patient has physical findings of noncritical aortic stenosis, but then has chest pains or faints, indicating that the stenosis is more significant. If the doctor orders an echo and the patient does not have critical aortic stenosis, you don’t do a heart catheterization, he says.

“By [the researchers’] criteria, that would say no change in therapy. That, to us, means you saved someone going through the cath lab. … There’s no way to measure that by the way they’ve done this,” Dr. Sherman said.

Proof of appropriate use

Dr. Sherman points out that the study shows that 92% of the tests were found to meet the appropriate use criteria the ACC established for the tests (link). He said he would like to see further study to understand how and why physicians order the tests and how they use them.

In an invited commentary, William Armstrong, MD, and Kim Eagle, MD, of the University of Michigan Health System, agreed that further prospective studies were needed and that educational initiatives targeting appropriate use of results, rather than just appropriate ordering, may get at some of the concerns raised by the study (link).

Echocardiograms make up more than half of all cardiac imaging. Medicare pays between $200 and $450 for each test and its reading, according to the ACC. In 2010, those tests make up $1.1 billion of total Medicare diagnostic imaging spending, according to the study’s authors, who say some of that money is wasted.

Lead study author Susan Matulevicius, MD, an assistant professor of internal medicine at UTSW Medical Center, said that even if the results only reassure the patient that the current management is working, that’s a reasonable cause for the test. But she said too often the tests are ordered reflexively for people unlikely to benefit from the results.

“I still think that echo is an extraordinarily important test, and I think it gives you a lot of information relatively quickly with very little risk to the patient, but I think that’s also where it can be overused, because it’s so low risk,” Dr. Matulevicius said.

Second study claims overuse

Another study posted online July 22 in JAMA Internal Medicine by researchers in Norway found no benefit over 15 years in ordering echocardiograms to assess cardiovascular risk in individuals in the general population without symptoms of heart failure, or a family history of sudden death or inherited heart disease.

DID YOU KNOW:
Echocardiograms make up more than half of all cardiac imaging.

Lead study author Dr. Haakon Lindekleiv of the University of Tromso in Norway, said his research supports the notion that echocardiography is overused (link).

There are two major problems with unwarranted testing, he said.

“The first is a financial one: Ordering echos is not cost-effective if it is unlikely to improve the patient’s health or prevent disease progression,” he stated in an email. “Second, unwarranted testing may be harmful to the patient as cardiac workup due to incidental findings on the echocardiogram may lead to anxiety, psychological harm and complications with little benefit.”

Back to top


ADVERTISEMENT

ADVERTISE HERE


Featured
Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story


Read story

Goodbye

American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story


Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story


Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story


Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story


Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story


Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story


Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story