Under-utilization of echocardiography in the management of congestive heart failure in the community has adverse effects on morbidity and mortality

Knowledge of cardiac structure and function is believed important in the management of patients (pts) with congestive heart failure (CHF) and ACC/AHA clinical practice guidelines recommend echocardiography (echo) in all pts with suspected CHF. The utilization of echo in the management of CHF in the community is unknown. Using the Rochester epidemiology project, we evaluated the use of echo in all pts receiving a new diagnosis(dx) of CHF in Olmsted County, MN in 1991. Only pts who satisfied Framingham Criteria for CHF were included (n= 232). In all, 84 (36%) pts did not undergo echo (or other assessment of EF) within 3 weeks before or after the dx of CHF. Characteristics of the No Echo and Echo groups are outlined below. ACEi=Angiotensin Converting Enzyme Inhibitor, Subseq.Hosp.= Subsequent hospitalization for CHF CHF-No Echo CHF-Echo p value Age (yrs,±sd) 81±10 75±14 0.002 Female (%) 68 55 0.07 NYHA II (%) 71 27 <0.001 CAD (%) 33 30 NS ACEi use(%) 26 55 <0.001 Digoxin use(%) 32 45 0.072 Subseq.Hosp. 52 72 <0.001 Both groups showed reduced survival as compared to age and sex matched populations. By multivariate analysis controlling for age, NYHA functional class and sex, having an echo was associated with a lower risk of death (RR=0.661, p=0.03). The No Echo pts were older and more likely to be female. While the No-Echo pts had milder symptoms at dx, 52% were later hospitalized for CHF-possibly related to under-treatment with digoxin and ACEi. In conclusion, underutilization of Echo in the management of CHF in the community appears to have an adverse effect on morbidity and mortality.