Trends in use of echocardiography in hospitalized patients with syncope

Abstract

Purpose We sought to assess the trends in use, predictors of echocardiography, and its impact on in‐hospital mortality in patients admitted with syncope using a large national database. Methods Utilizing the Nationwide Inpatient Sample (NIS) database from 2001 to 2014, we identified adult patients (>18 years) with a primary discharge diagnosis of syncope and use of echocardiogram was ascertained. Results A total of 3 174 619 patients with a primary discharge diagnosis of syncope were identified, of which 184 167 (5.8%) underwent an echocardiogram. The rate of syncope hospitalization remained constant between 2001 and 2009 (1.1/1000 US population) but has since decreased steadily to about 0.5/1000 US population in 2014. After adjusting for patient and hospital characteristics, the rate of echocardiogram use increased significantly from 5.1% in 2001 to 6.8% in 2014 (2.7% relative increase per year [Ptrend = 0.024]). Predictors of use were cardiac disorders, hypertension, diabetes, peripheral vascular disease, and renal failure. After adjusting for baseline risk, use of echocardiography was not associated with in‐hospital mortality (OR = 0.827, P = 0.155), but was associated with a 14.6% increase in adjusted length of stay and a 22.6% increase in adjusted hospital cost compared to no echocardiography use (both P < 0.001). Conclusions The admission rates for syncope are decreasing and use of echocardiography in hospitalized patients with syncope is appropriately low. Given the lack of any favorable impact on mortality and the association with increased costs, there is a continued need to emphasize evidence‐based use of echocardiography in patients presenting with syncope.

Prevalence of different echocardiographic abnormalities in a large Turkish workers population

“…In another study, Satish et al. reported that, 3 174 619 patients with syncope were evaluated, and the performing of echocardiography did not effect the in‐hospital mortality rates ( p = .155), but was related with a 14.6% rise in length of hospitalization and a 22.6 % in‐hospital cost compared the not using of echocardiography ( p < .001, p < .001, respectively) 19 …”

“…Also, the high mean age of this group may have caused to the more echocardiographic abnormalities.In this study, no possible TTE findings were determined to explain this complaint in the group with recurrent syncope attacks. As possible causes included severe aortic or mitral valve disorder, severe LV dilatacost compared the not using of echocardiography (p < .001, p < .001, respectively) 19. The American Heart Association and European Society of Cardiology recommend echocardiography in patients with syncope only if the patient's history or examination suggests a cardiac etiology or if the baseline ECG is abnormal 20,21.…”