This post was authored by Neil J. Weissman, MD, FASE, FACC, president-elect of the American Society of Echocardiography.

Last week, JAMA Internal Medicine published two articles which have gotten substantial media attention questioning the value of echocardiography.  Both studies examine the utility of echocardiography in different settings.

The first study, Appropriate Use and Clinical Impact of Transthoracic Echocardiography (TTE) found that, while approximately 92 percent of echoes performed in April 2011 were deemed “appropriate” using Appropriate Use Criteria (AUC), only about 1 in 3 resulted in an “active change in care.” The media contend that these results imply that the 2011 AUC for Echocardiography, which were endorsed by the ACC and ASE in partnership with other subspecialty organizations, are flawed and that an echo should only be performed if it is likely to result in an active change in care.  Of special concern is the contention that these results could be extrapolated to the population as a whole, and could result in $230 million dollars of savings for Medicare.

The second study, Echocardiographic Screening of the General Population and Long-term Survival, found that echocardiographic screening for structural and valvular heart disease in the general population provided no benefit for mortality or for the risk of myocardial infarction or stroke.

While these studies make some interesting points, it is important to remember that echocardiography is safe, relatively low-cost, and often the only way to accurately detect a variety of disease states.  Echocardiograms are beneficial in many ways, including confirming that the management plan already in place is the correct one. As pointed out in the accompanying editorial by William Armstrong, MD, FACC, and Kim A. Eagle, MD, MACC, performing an echocardiogram and then maintaining the same care does not indicate that the study was inappropriate. Consider an oncology patient on chemotherapy where the clinician is concerned about cardiotoxicity.  An echocardiogram that demonstrates normal left ventricular function that allows continuation of life-saving chemotherapy is extremely valuable but, as per this study, would be classified as “no change in therapy.”  

Both the ACC and ASE continue to focus on efforts to ensure that the appropriate cardiovascular test is performed on the right person at the right time to promote patient safety and optimal cardiac health. Neither organization supports using echo to screen low-risk, asymptomatic patients, nor does the AUC endorse this type of generalized screening.

As part of the commitment to ensuring the appropriate use of echocardiography, ASE is a partner in the Choosing Wisely^® campaign, of which ACC is also a partner. The campaign is an important effort spearheaded by the American Board of Internal Medicine Foundation to help identify and act on overuse or misuse of tests or procedures in the health care system. Additionally, as the result of a grant from the Robert Johnson Wood Foundation, ASE will soon be releasing a free mobile Echo AUC app, an interactive tool designed to help physicians determine if an echo is appropriate for a specific patient.

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