Abstract 81: Appropriateness And Clinical Utility Of Echocardiograms For (Pre)Syncope And Palpitations In An Academic Primary Care Practice
Introduction: Patients with (pre)syncope and palpitations are often assessed in primary care clinic. Guidelines recommend evaluation with history, physical exam, and an EKG followed by a transthoracic echocardiogram (TTE) only when structural heart disease is suspected.
Hypothesis: We hypothesized that many TTEs ordered for (pre)syncope and palpitations from primary care clinic do not meet appropriateness criteria.
Methods: We reviewed charts for TTE orders for (pre)syncope and palpitations from the primary care clinics of a large academic health system from 9/1/20 – 4/30/21. We extracted visit type, evaluation completed prior to the TTE order, and TTE findings. Appropriateness was assessed based on published clinical guidelines and practice recommendations.
Results: During the study period, 6.0% of all TTEs ordered (31/520) were for (pre)syncope and 5.4% were for palpitations. Of these, 39% for (pre)syncope and 46% for palpitations met appropriateness criteria. At the time of the TTE order, 51% (30/59) of patients had a recent physical exam and 63% (37/59) had an EKG or cardiac monitor completed in the past 6 months. Of the visits completed, 42% (25/59) were virtual / telemedicine, and the rate of TTE appropriateness did not differ between virtual and in-person visits (40%, 10/25 vs 44%, 15/34, p=0.752). Of the TTEs completed, 7% (2/29) for (pre)syncope and 17% (4/23) for palpitations revealed clinically significant findings. The proportion of TTEs with clinically significant findings was low for both studies deemed appropriate and inappropriate (14.3%, 3/21 vs 9.7%, 3/31, p=0.610).
Conclusions: At this primary care practice, a large proportion of TTEs ordered for (pre)syncope and palpitations did not meet appropriateness criteria. Few TTEs deemed inappropriate revealed clinically significant findings. Improved education and decision support for these clinical scenarios may increase appropriate use of cardiac imaging and decrease costs.
