Background and Purpose:
It
is unclear whether it is clinically necessary or cost-effective to
routinely obtain a transthoracic echocardiogram (TTE) during inpatient
admission for ischemic stroke.
Methods:
We
assessed consecutive patients presenting with acute ischemic stroke at a
comprehensive stroke center from 2015 to 2017 who underwent TTE. We
assessed for findings on TTE that would warrant urgent intervention
including cardiac thrombus, atrial myxoma, mitral stenosis, valve
vegetation, valve dysfunction requiring surgery, and low ejection
fraction. Subsequent changes in management included changes in
anticoagulation, antibiotics, or valve surgery. We calculated
in-hospital resource utilization and associated costs for inpatient TTE
using individual direct cost details within a case-costing system.
Results:
Of
695 patients admitted with acute ischemic stroke, 516 (74%) had a TTE
and were included in our analysis. TTE findings were potentially
clinically significant in 30 patients (5.8%) and changed management in
17 patients (3.3%). Inpatient admission was prolonged to expedite TTE in
24 patients, while TTE occurred after discharge in 76 patients. After
correcting for the cost of TTE, the mean difference in cost to prolong
an admission for TTE was $555.52 (USD), or $16 832 per change in
management.
Conclusions:
Given
the low clinical utility of inpatient TTE after acute ischemic stroke
and the costs associated with prolonging admission, discharge from
hospital should not be delayed solely to obtain TTE.
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