High echo usage comes with increased costs, no difference in outcomes

Hospitals that perform more echocardiography exams in patients with acute myocardial infarction (AMI) do not see any improvements in patient outcomes, according to a recent study published in JAMA Internal Medicine.

In fact, among the nearly 400 U.S. hospitals included in the study, those that performed more exams were associated with longer length of stay and greater costs, reported first author Quinn R. Pack, MD, MSc, with the University of Massachusetts Medical School-Baystate Division of Cardiovascular Medicine in Springfield, and colleagues.

“Although echocardiography plays an important role in the treatment of many patients with AMI, these findings suggest that a more selective approach may be safe and may reduce costs, particularly at high-use hospitals,” the researchers added.

Pack and colleagues retrospectively studied data from 397 hospitals that contributed to the Premier Healthcare Informatics inpatient database from January 2014 to December 31, 2014. ICD-9 codes were used to identify 98,999 hospital admissions for patients with AMI.

Overall, more than 70% of patients hospitalized for AMI received an echocardiogram. Usage rates varied across hospitals, the lowest quartile had median echocardiography use rates of 54% and the highest had 83%.

After adjusting for hospital and patient characteristics, the researchers found no difference in inpatient mortality or 3-month readmission between the highest and lowest quartiles. Hospitals with the highest use rates of echocardiography had longer mean lengths of stay (0.23 days) and higher mean costs ($3,164) per admission compared to institutions in the lowest quartile.

According to the authors, their results contrast a study which associated echocardiography to a 26% lower risk of mortality in AMI.

The correlation between exams ordered and increased costs may indicate more than just high echocardiography usage rates, the authors explained.

“The higher costs noted at hospitals with high echocardiography usage may reflect a hospital culture that encourages more testing, procedures, and resource use overall.” Pack et al. concluded. “Hospitals with higher rates of echocardiography use also showed higher rates of nuclear testing and invasive ventriculography and greater use of intensive care unit services.”