1256. Utilization of Transthoracic Echocardiogram among Hospitalizations for Hemorrhagic Stroke
Authors: Hannah Kristen Weiss; Roxanna Garcia; Pouya Nazari, MD; Pedram Golnari, MD; Shyam Prabhakaran; Sanjiv Shah, MD; Andrew Naidech; Babak Jahromi (Chicago, IL)
There are limited guidelines outlining echocardiogram indications for patients with hemorrhagic stroke. We described the utilization of transthoracic echocardiograms (TTE) in patients hospitalized for spontaneous intraparenchymal hemorrhage (IPH) and correlated these findings with frequency of acute myocardial events and major cardiac procedures.
The Nationwide Inpatient Sample database was used to identify patients hospitalized with IPH from 2007 to 2015. Additional, prospective data was collected from a single-center database from 2007 to 2018. We compared demographic data, hospital characteristics, cardiovascular risk factors, comorbidities, hospital course and cardiac outcomes between patient hospitalizations receiving TTE and those not receiving TTE. A time trend analysis of TTE by year was performed and stratified by hospital teaching status.
Among the 140,574 patients meeting the inclusion criteria in the multicenter cohort, 7,582 (5.4%) hospitalizations underwent a TTE. Hospitalizations at teaching hospitals had higher rates of echocardiogram utilization (P<0.001), however there was no difference in major cardiac procedures (P=0.42). Among a single-center cohort, 406 patients with IPH underwent a TTE, with echocardiogram findings most consistent with mild hypertensive heart disease. In both cohorts, TTE utilization was associated with decreased in-hospital mortality (P<0.001) and decreased disease severity (P <0.001).
Teaching hospitals utilize echocardiograms for IPH hospitalizations at higher rates than non-teaching hospitals. It is difficult to discern if performing an echocardiogram results in measurable changes in clinical management and patient outcomes.