Association between Inpatient Echocardiography Use and Outcomes in Adult Patients with Acute Myocardial Infarction

Quinn R. Pack*, Aruna Priya, Tara Lagu, Penelope S. Pekow, Joshua P. Schilling, William L. Hiser, Peter K. Lindenauer

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Importance: Guidelines recommend that patients with acute myocardial infarction (AMI) undergo echocardiography for assessment of cardiac structure and ejection fraction, but little is known about the association between echocardiography as used in routine clinical management of AMI and patient outcomes. Objective: To examine the association between risk-standardized hospital rates of transthoracic echocardiography and outcomes. Design, Setting, and Participants: This retrospective cohort study of data from 397 US hospitals that contributed to the Premier Healthcare Informatics inpatient database from January 1, 2014, to December 31, 2014, used International Classification of Diseases, Ninth Revision (ICD-9) codes to identify 98999 hospital admissions for patients with AMI. Data were analyzed between October 2017 and January 2019. Exposures: Rates of transthoracic echocardiography. Main Outcomes and Measures: Inpatient mortality, length of stay, total inpatient costs, and 3-month readmission rate. Results: Among the 397 hospitals with more than 25 admissions for AMI in 2014, a total of 98999 hospital admissions for AMI were identified for analysis (38.2% women; mean [SD] age, 66.5 [13.6] years), of which 69652 (70.4%) had at least 1 transthoracic echocardiogram performed. The median (IQR) hospital risk-standardized rate of echocardiography was 72.5% (62.6%-79.1%). In models that adjusted for hospital and patient characteristics, no difference was found in inpatient mortality (odds ratio [OR], 1.02; 95% CI, 0.88-1.19) or 3-month readmission (OR, 1.01; 95% CI, 0.93-1.10) between the highest and lowest quartiles of echocardiography use (median risk-standardized echocardiography use rates of 83% vs 54%, respectively). However, hospitals with the highest rates of echocardiography had modestly longer mean lengths of stay (0.23 days; 95% CI, 0.04-0.41; P =.01) and higher mean costs (3164; 95% CI, 1843-4485; P <.001) per admission compared with hospitals in the lowest quartile of use. Multiple sensitivity analyses yielded similar results. Conclusions and Relevance: In patients with AMI, hospitals in the quartile with the highest rates of echocardiography showed greater hospital costs and length of stay but few differences in clinical outcomes compared with hospitals in the quartile with the lowest rates of echocardiography. These findings suggest that more selective use of echocardiography might be used without adversely affecting clinical outcomes, particularly in hospitals with high rates of echocardiography use.

Original languageEnglish (US)
Pages (from-to)1176-1185
Number of pages10
JournalJAMA internal medicine
Issue number9
StatePublished - Sep 2019
Externally publishedYes

ASJC Scopus subject areas

  • Internal Medicine


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