Feasibility, diagnostic performance and clinical value of an abbreviated echocardiography protocol in an out-patient cardiovascular setting: a pilot study.

BACKGROUND: There has been a growing demand for echocardiography services over the last 5 years, with this supply-demand mismatch exacerbated by the COVID-19 pandemic. Prior studies have suggested a high proportion of normal findings among echocardiograms requested for patients without known cardiovascular disease, particularly in low-risk cohorts. This pilot study investigates the role of an abbreviated echocardiography protocol in improving access to echocardiography services in a low-risk outpatient setting within the rapid access chest pain (RACP) clinic. METHOD: A retrospective review of electronic medical records and transthoracic echocardiography (TTE) studies for 212 patients from RACP clinic in 2019 (cohort A), prior to the introduction of the abbreviated echocardiography protocol, and 175 patients seen in the RACP clinic in 2021 (cohort B) was performed. The outcomes measured include the echocardiography referral burden from RACP clinic, waiting time for a TTE and echocardiography findings. RESULTS: 33% and 45% of patients seen in the RACP clinic in 2019 and 2021, respectively, were referred for a TTE. The most common indications include chest pain (50%), dyspnoea (19%) and palpitations (11%). Abnormal findings were identified in 36% of TTEs performed in cohort A and 13% in cohort B. The median echocardiogram study time was significantly shorter in cohort B (7 min vs 13 min, p < 0.00001), with a lower number of images acquired (43 vs. 62, p < 0.00001). The median waiting time for an echocardiography in cohort B was significantly shorter (median: 14 days vs. 42 days in 2019, p < 0.00001). No major pathologies were missed on a retrospective review of these images. CONCLUSION: Our study demonstrates that an abbreviated echocardiography protocol has potential to improve access to echocardiography services through increasing scheduling capacity, without compromising diagnostic performance in a low-risk outpatient population.

Triage of cardiac imaging testing did not impact patient outcomes in a large cardiac network during the covid-19 pandemic

160 Table 1Demographic and outcome data for patients with cancelled or completed cardiac scans during the first wave of the COVID-19 pandemic 160 Figure 1All cause mortality in patients with cancelled or completed outpatients cardiac tests from the time of the first round of cancellations (18/04/2020) at the beginning of the COVID-19 pandemic. Clinically urgent scans, as triaged by expert clinicians, were completed, and others cancelled. Mortality was greater for those with completed scans detected over a mean follow-up of 581 days. (B) Acute admissions to emergency, cardiac or cardiothoracic services in patients with cancelled or completed cardiac tests after cancellations of low-risk patients. In keeping with triage, patients with completed scans had worse outcomes. Patients with low-risk clinical features had a reassuring rate of admission[Figure omitted. See PDF]ConclusionOur approach to diagnostic testing in cardiology during the first wave of the COVID-19 pandemic accurately identified and tested high-risk patients without causing harm to those at lower risk, demonstrated by higher admission rates in patients in whom tests were performed, and the absence of an adverse impact on mortality. 49% of patients underwent subsequent cardiac testing after a cancelled test. We maintained low waiting times throughout the pandemic.Conflict of InterestNone