Use of Echocardiography in Olmsted County Outpatients With Chest Pain and Normal Resting Electrocardiograms Seen at Mayo Clinic Rochester

Raymond J Gibbons, Damita Carryer, Hongfang D Liu, Peter A. Brady, J. Wells Askew, David Hodge, Naser Ammash, Jon Owen Ebbert, Veronique Lee Roger

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Abstract

Objective: To determine how often unnecessary resting echocardiograms that are "not recommended" by clinical practice guidelines are performed in patients with stable chest pain and normal resting electrocardiograms (ECGs). Patients and Methods: We performed a retrospective search of electronic medical records of all outpatients seen at Mayo Clinic Rochester from January 1, 2010, through December 31, 2013, to identify residents of Olmsted County, Minnesota, with stable chest pain and known or suspected coronary artery disease who underwent resting echocardiography and had normal resting ECGs and no other indication for echocardiography. Results: Of the 8280 outpatients from Olmsted County who were evaluated at Mayo Clinic Rochester with chest pain, 590 (7.1%) had resting echocardiograms. Ninety-two of these 590 patients (15.6%) had normal resting ECGs. Thirty-three of these 92 patients (35.9%) had other indications for echocardiography. The remaining 59 patients (10.0% of all echocardiograms and 0.7% of all patients) had normal resting ECGs and no other indication for echocardiography. Fifty-seven of these 59 patients (96.6%) had normal echocardiograms. Thirteen of these 59 echocardiograms (22.0%) were "preordered" before the provider (physicians, nurses, physician assistants) visit. Conclusion: The overall rate of echocardiography in Olmsted County outpatients with chest pain seen at Mayo Clinic Rochester is low. Only 1 in 10 of these echocardiograms was performed in violation of the class III recommendation in the American College of Cardiology Foundation/American Heart Association guidelines for the management of stable angina. These unnecessary echocardiograms were almost always normal. The rate of unnecessary echocardiograms could be decreased by eliminating preordering.

Original languageEnglish (US)
JournalMayo Clinic Proceedings
DOIs
StateAccepted/In press - 2015

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Chest Pain
Echocardiography
Electrocardiography
Outpatients
Physician Assistants
Stable Angina
Electronic Health Records
Practice Guidelines
Coronary Artery Disease
Nurses
Guidelines
Physicians

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{435cf1981f714f1ebbcac70bfe7c36e0,
title = "Use of Echocardiography in Olmsted County Outpatients With Chest Pain and Normal Resting Electrocardiograms Seen at Mayo Clinic Rochester",
abstract = "Objective: To determine how often unnecessary resting echocardiograms that are {"}not recommended{"} by clinical practice guidelines are performed in patients with stable chest pain and normal resting electrocardiograms (ECGs). Patients and Methods: We performed a retrospective search of electronic medical records of all outpatients seen at Mayo Clinic Rochester from January 1, 2010, through December 31, 2013, to identify residents of Olmsted County, Minnesota, with stable chest pain and known or suspected coronary artery disease who underwent resting echocardiography and had normal resting ECGs and no other indication for echocardiography. Results: Of the 8280 outpatients from Olmsted County who were evaluated at Mayo Clinic Rochester with chest pain, 590 (7.1{\%}) had resting echocardiograms. Ninety-two of these 590 patients (15.6{\%}) had normal resting ECGs. Thirty-three of these 92 patients (35.9{\%}) had other indications for echocardiography. The remaining 59 patients (10.0{\%} of all echocardiograms and 0.7{\%} of all patients) had normal resting ECGs and no other indication for echocardiography. Fifty-seven of these 59 patients (96.6{\%}) had normal echocardiograms. Thirteen of these 59 echocardiograms (22.0{\%}) were {"}preordered{"} before the provider (physicians, nurses, physician assistants) visit. Conclusion: The overall rate of echocardiography in Olmsted County outpatients with chest pain seen at Mayo Clinic Rochester is low. Only 1 in 10 of these echocardiograms was performed in violation of the class III recommendation in the American College of Cardiology Foundation/American Heart Association guidelines for the management of stable angina. These unnecessary echocardiograms were almost always normal. The rate of unnecessary echocardiograms could be decreased by eliminating preordering.",
author = "Gibbons, {Raymond J} and Damita Carryer and Liu, {Hongfang D} and Brady, {Peter A.} and Askew, {J. Wells} and David Hodge and Naser Ammash and Ebbert, {Jon Owen} and Roger, {Veronique Lee}",
year = "2015",
doi = "10.1016/j.mayocp.2015.07.025",
language = "English (US)",
journal = "Mayo Clinic Proceedings",
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publisher = "Elsevier Science",

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T1 - Use of Echocardiography in Olmsted County Outpatients With Chest Pain and Normal Resting Electrocardiograms Seen at Mayo Clinic Rochester

AU - Gibbons, Raymond J

AU - Carryer, Damita

AU - Liu, Hongfang D

AU - Brady, Peter A.

AU - Askew, J. Wells

AU - Hodge, David

AU - Ammash, Naser

AU - Ebbert, Jon Owen

AU - Roger, Veronique Lee

PY - 2015

Y1 - 2015

N2 - Objective: To determine how often unnecessary resting echocardiograms that are "not recommended" by clinical practice guidelines are performed in patients with stable chest pain and normal resting electrocardiograms (ECGs). Patients and Methods: We performed a retrospective search of electronic medical records of all outpatients seen at Mayo Clinic Rochester from January 1, 2010, through December 31, 2013, to identify residents of Olmsted County, Minnesota, with stable chest pain and known or suspected coronary artery disease who underwent resting echocardiography and had normal resting ECGs and no other indication for echocardiography. Results: Of the 8280 outpatients from Olmsted County who were evaluated at Mayo Clinic Rochester with chest pain, 590 (7.1%) had resting echocardiograms. Ninety-two of these 590 patients (15.6%) had normal resting ECGs. Thirty-three of these 92 patients (35.9%) had other indications for echocardiography. The remaining 59 patients (10.0% of all echocardiograms and 0.7% of all patients) had normal resting ECGs and no other indication for echocardiography. Fifty-seven of these 59 patients (96.6%) had normal echocardiograms. Thirteen of these 59 echocardiograms (22.0%) were "preordered" before the provider (physicians, nurses, physician assistants) visit. Conclusion: The overall rate of echocardiography in Olmsted County outpatients with chest pain seen at Mayo Clinic Rochester is low. Only 1 in 10 of these echocardiograms was performed in violation of the class III recommendation in the American College of Cardiology Foundation/American Heart Association guidelines for the management of stable angina. These unnecessary echocardiograms were almost always normal. The rate of unnecessary echocardiograms could be decreased by eliminating preordering.

AB - Objective: To determine how often unnecessary resting echocardiograms that are "not recommended" by clinical practice guidelines are performed in patients with stable chest pain and normal resting electrocardiograms (ECGs). Patients and Methods: We performed a retrospective search of electronic medical records of all outpatients seen at Mayo Clinic Rochester from January 1, 2010, through December 31, 2013, to identify residents of Olmsted County, Minnesota, with stable chest pain and known or suspected coronary artery disease who underwent resting echocardiography and had normal resting ECGs and no other indication for echocardiography. Results: Of the 8280 outpatients from Olmsted County who were evaluated at Mayo Clinic Rochester with chest pain, 590 (7.1%) had resting echocardiograms. Ninety-two of these 590 patients (15.6%) had normal resting ECGs. Thirty-three of these 92 patients (35.9%) had other indications for echocardiography. The remaining 59 patients (10.0% of all echocardiograms and 0.7% of all patients) had normal resting ECGs and no other indication for echocardiography. Fifty-seven of these 59 patients (96.6%) had normal echocardiograms. Thirteen of these 59 echocardiograms (22.0%) were "preordered" before the provider (physicians, nurses, physician assistants) visit. Conclusion: The overall rate of echocardiography in Olmsted County outpatients with chest pain seen at Mayo Clinic Rochester is low. Only 1 in 10 of these echocardiograms was performed in violation of the class III recommendation in the American College of Cardiology Foundation/American Heart Association guidelines for the management of stable angina. These unnecessary echocardiograms were almost always normal. The rate of unnecessary echocardiograms could be decreased by eliminating preordering.

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